Healthcare Provider Details

I. General information

NPI: 1154512689
Provider Name (Legal Business Name): DAVID FARMER CST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 N CURTIS RD STE 300
BOISE ID
83706-1300
US

IV. Provider business mailing address

1075 N CURTIS RD STE 300
BOISE ID
83706-1300
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-2600
  • Fax: 208-323-9172
Mailing address:
  • Phone: 208-323-2600
  • Fax: 208-323-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: