Healthcare Provider Details

I. General information

NPI: 1760645758
Provider Name (Legal Business Name): DAVID FARMER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7616 TRANSIT RD
WILLIAMSVILLE NY
14221-6017
US

IV. Provider business mailing address

PO BOX 5101
BUFFALO NY
14240-5101
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-2273
  • Fax: 716-817-9905
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-362-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012600
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: