Healthcare Provider Details

I. General information

NPI: 1861429953
Provider Name (Legal Business Name): RYAN SHURTLIFF FARRER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 BASICH BLVD ABERDEEN
ABERDEEN WA
98520-1066
US

IV. Provider business mailing address

14301 FNB PKWY STE 100
OMAHA NE
68154-7200
US

V. Phone/Fax

Practice location:
  • Phone: 360-533-0400
  • Fax: 360-533-5633
Mailing address:
  • Phone: 402-493-1212
  • Fax: 888-972-1672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDO-05903
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOP00001975
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: