Healthcare Provider Details

I. General information

NPI: 1942050463
Provider Name (Legal Business Name): ADAM DONALD FARMER MBBS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1008 S. SPRING OFFICE 2204 SLU CARE ACADEMIC PAVILLION
ST LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-3552
  • Fax:
Mailing address:
  • Phone: 314-327-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2023045808
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: