Healthcare Provider Details

I. General information

NPI: 1710162714
Provider Name (Legal Business Name): ROBERT E FARMER II RRT RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4191 BLACKSMITH CV
MEMPHIS TN
38125-2611
US

IV. Provider business mailing address

4191 BLACKSMITH CV
MEMPHIS TN
38125-2611
US

V. Phone/Fax

Practice location:
  • Phone: 901-650-5218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License NumberRCP3540
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number3997
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: