Healthcare Provider Details

I. General information

NPI: 1285703454
Provider Name (Legal Business Name): JOHN MITCHELL FARMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 EXECUTIVE PARK
LOUISVILLE KY
40207-4205
US

IV. Provider business mailing address

512 EXECUTIVE PARK
LOUISVILLE KY
40207-4205
US

V. Phone/Fax

Practice location:
  • Phone: 502-894-0266
  • Fax: 502-894-0737
Mailing address:
  • Phone: 502-894-0266
  • Fax: 502-894-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberXF7678521
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number19060
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: