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NPI Code Detail

MEDICARE: TILLMAN FARLEY MD

MEDICARE: TILLMAN FARLEY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianDR.0035760CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013993682
Entity Type Code : Individual
Provider Name (Legal Business Name) : TILLMAN FARLEY MD
Provider Business Mailing Address
First Line : 203 S ROLLIE AVE
Second Line :
City : FORT LUPTON
State : CO
Zip : 80621-1508
Country : US
Telephone Number : 303-857-2771
Fax Number : 720-322-9434
Provider Business Practice Location Address
First Line : 1115 2ND ST
Second Line :
City : FORT LUPTON
State : CO
Zip : 80621-1745
Country : US
Telephone Number : 303-857-2771
Fax Number : 720-322-9434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 11/07/2013

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Directions to “ TILLMAN FARLEY MD” Practice Location

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