MEDICARE: DR. BLAKE HOUSTON FARRAR DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	TP019	KY

General Provider Information

NPI Number	:	1366011264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAKE HOUSTON FARRAR DO

Provider Business Mailing Address
First Line	:	1901 CAMPUS PL
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 EASTPOINT PKWY STE 410
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4154
Country	:	US
Telephone Number	:	502-253-6625
Fax Number	:	502-253-6629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	05/19/2026

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