=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033380431
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER FARMER M.D. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2008
-----------------------------------------------------
Last Update Date | 03/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 274 ONE AND HALF S RAMPART BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-368-1113
-----------------------------------------------------
Fax | 213-368-1313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 274 ONE AND HALF S RAMPART BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-368-1113
-----------------------------------------------------
Fax | 213-368-1313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | DR. PETER FARMER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 213-368-1113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | G16643
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------