Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 217712 | NY |
N | 111NI0900X | Internist | 217712 | NY |
N | 207R00000X | Internist | 61844 | CT |
N | 111NI0900X | Internist | 61844 | CT |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 217712 | NY |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | T2599 | TX |
N | 207RC0000X | Internist - Cardiovascular Disease | 217712 | NY |
NPI | 1700976974 |
---|---|
Provider Name | Maryjane A. Farr |
First Address | Dallas, TX 75284-7208 |
Second Address | Dallas, TX 75390-3720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 10/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02591413 | (05) | NY |
61844 | CT STATE LICENSE (01) | CT |