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NPI Code Detail

MEDICARE: DR. ROBERT T. FARMER M.D.

MEDICARE: DR. ROBERT T. FARMER 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
1207Q00000XFamily Medicine Physician036097185IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CI4390OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18221911OTHERILBCBS OF ILLINOIS

General Provider Information

NPI Number : 1629058102
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT T. FARMER M.D.
Provider Business Mailing Address
First Line : 211 E HANOVER ST
Second Line :
City : NEW BADEN
State : IL
Zip : 62265-1811
Country : US
Telephone Number : 618-588-2900
Fax Number : 618-588-2904
Provider Business Practice Location Address
First Line : 211 E HANOVER ST
Second Line :
City : NEW BADEN
State : IL
Zip : 62265-1811
Country : US
Telephone Number : 618-588-2900
Fax Number : 618-588-2904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 03/10/2011

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