Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 77879 | NC |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101242061 | VA |
NPI | 1013988161 |
---|---|
Provider Name | James Mastin Farmer |
First Address | Brentwood, TN 37027-4692 |
Second Address | Salem, VA 24153-5404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013988161 | (05) | VA |
P00621112 | MEDICARE RAILROAD (01) | VA |