Healthcare Provider Details

I. General information

NPI: 1720172190
Provider Name (Legal Business Name): JULIE FARRER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE SUITE 102
ALBUQUERQUE NM
87109-1234
US

IV. Provider business mailing address

4705 MONTGOMERY BLVD NE SUITE 102
ALBUQUERQUE NM
87109-1234
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7833
  • Fax: 505-727-6944
Mailing address:
  • Phone: 505-727-7833
  • Fax: 505-727-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number96208
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number96-208
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: