MEDICARE: SUZANNA RENNE FARMER PA

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	363A00000X	Physician Assistant	PATEMP	TX

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	:	1699806851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNA RENNE FARMER PA

Provider Business Mailing Address
First Line	:	1125 COLLEGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4514
Country	:	US
Telephone Number	:	817-810-9810
Fax Number	:	817-810-9815

Provider Business Practice Location Address
First Line	:	1125 COLLEGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4514
Country	:	US
Telephone Number	:	817-810-9810
Fax Number	:	817-810-9815

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	01/08/2010

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Directions to “ SUZANNA RENNE FARMER PA” Practice Location

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