=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942050463
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM DONALD FARMER MBBS, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2024
-----------------------------------------------------
Last Update Date | 03/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 S GRAND BLVD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63104-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-617-3552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1008 S. SPRING OFFICE 2204 SLU CARE ACADEMIC PAVILLION
-----------------------------------------------------
City | ST LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-327-0016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 2023045808
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------