Healthcare Provider Details

I. General information

NPI: 1013101211
Provider Name (Legal Business Name): ROBERT FARMER MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E HANOVER ST
NEW BADEN IL
62265-1811
US

IV. Provider business mailing address

211 E HANOVER ST
NEW BADEN IL
62265-1811
US

V. Phone/Fax

Practice location:
  • Phone: 618-588-2900
  • Fax: 618-588-2904
Mailing address:
  • Phone: 618-588-2900
  • Fax: 618-588-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0036097185
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT FARMER
Title or Position: OWNER
Credential: MD
Phone: 618-588-2900