Provider Demographics
NPI:1679590384
Name:JOHN H FARRER MD
Entity type:Organization
Organization Name:JOHN H FARRER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FARRER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-413-8405
Mailing Address - Street 1:703 LILLY ROAD NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-413-8200
Mailing Address - Fax:360-413-8850
Practice Address - Street 1:703 LILLY ROAD NE
Practice Address - Street 2:SUITE 104
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-413-8200
Practice Address - Fax:360-413-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8854855Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER