Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1356610596 |
---|---|
Provider Name | Randolph Farley |
First Address | San Antonio, TX 78229-3325 |
Second Address | San Antonio, TX 78229-3325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2011 |
Last Update Date | 16/12/2011 |