Healthcare Provider Details

I. General information

NPI: 1942827183
Provider Name (Legal Business Name): MICHAEL DALE ANTHONY FARRAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL DALE ANTHONY FARRAN-BROWN PA-C

II. Dates (important events)

Enumeration Date: 07/04/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE C405
LEXINGTON KY
40504-1748
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-4429
  • Fax: 859-313-1095
Mailing address:
  • Phone:
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC975
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: