Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 01036562A | IN |
N | 208D00000X | General Practice Physician | 01036562A | IN |
NPI | 1831379445 |
---|---|
Provider Name | Peter Donald Farr |
First Address | Fishers, IN 46038-2632 |
Second Address | Fishers, IN 46038-2632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2007 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100090810 | (05) | IN |
170270F | MEDICARE (01) | IN |
1831379445 | NPI (01) | IN |