Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G042378 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | G042378 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | G042378 | CA |
NPI | 1124186085 |
---|---|
Provider Name | Thomas R Farnham |
First Address | San Francisco, CA 94103-1566 |
Second Address | Los Angeles, CA 90033-1065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 13/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E15051 | (02) | CA |