Healthcare Provider Details

I. General information

NPI: 1518966969
Provider Name (Legal Business Name): FARLAN COOEYATE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US DHHS INDIAN HEALTH SERVICE ROUTE 301 NORTH B STREET
ZUNI NM
87327-0467
US

IV. Provider business mailing address

PO BOX 467
ZUNI NM
87327-0467
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-4431
  • Fax: 505-782-7551
Mailing address:
  • Phone: 505-782-4431
  • Fax: 505-782-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberCERT. 1008587
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: