MEDICARE: DERALD FARRIMOND M.D.

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
1	2084P0800X	Psychiatry Physician	11997	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1215901376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERALD FARRIMOND M.D.

Provider Business Mailing Address
First Line	:	8936 SPANISH RIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1354
Country	:	US
Telephone Number	:	702-998-2816
Fax Number	:	702-998-2991

Provider Business Practice Location Address
First Line	:	7324 W CHEYENNE AVE STE 7
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7426
Country	:	US
Telephone Number	:	702-575-9705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	10/08/2019

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