Healthcare Provider Details

I. General information

NPI: 1275735086
Provider Name (Legal Business Name): DUSKY R. FARMER, DPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 UPPER MOUNT VERNON RD
EVANSVILLE IN
47712-6421
US

IV. Provider business mailing address

4501 UPPER MOUNT VERNON RD
EVANSVILLE IN
47712-6421
US

V. Phone/Fax

Practice location:
  • Phone: 812-421-8555
  • Fax: 812-402-2139
Mailing address:
  • Phone: 812-421-8555
  • Fax: 812-402-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number07000944A
License Number StateIN

VIII. Authorized Official

Name: DR. DUSKY RIDEOUT FARMER
Title or Position: OWNER
Credential: DPM
Phone: 812-421-8555