Healthcare Provider Details

I. General information

NPI: 1831379445
Provider Name (Legal Business Name): PETER DONALD FARR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10967 ALLISONVILLE RD 110
FISHERS IN
46038-2632
US

IV. Provider business mailing address

10967 ALLISONVILLE RD 110
FISHERS IN
46038-2632
US

V. Phone/Fax

Practice location:
  • Phone: 317-559-7970
  • Fax: 317-559-7971
Mailing address:
  • Phone: 317-559-7970
  • Fax: 317-559-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number01036562A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01036562A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number01036562A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: