Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 52757 | SC |
Y | 208600000X | Surgeon | 52757 | SC |
N | 208200000X | Surgeon | ME115864 | FL |
N | 208600000X | Surgeon | ME115864 | FL |
N | 2086S0102X | Surgical Critical Care | 52757 | SC |
N | 2086S0102X | Surgical Critical Care | ME115864 | FL |
N | 2086S0127X | Trauma Surgeon | ME115864 | FL |
NPI | 1215116850 |
---|---|
Provider Name | Jason Paul Farrah |
First Address | Myrtle Beach, SC 29572-4181 |
Second Address | Asheville, NC 28801-4550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2007 |
Last Update Date | 04/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5910544 | (05) | NC |