Healthcare Provider Details

I. General information

NPI: 1285958637
Provider Name (Legal Business Name): SANDI J FARRIS DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 W FOWLER CIR
WILLOW AK
99688
US

IV. Provider business mailing address

PO BOX 941
WILLOW AK
99688
US

V. Phone/Fax

Practice location:
  • Phone: 907-495-0483
  • Fax:
Mailing address:
  • Phone: 907-495-0483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberAA 409
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: