MEDICARE: SHANE FARR P.A.

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

General Provider Information

NPI Number	:	1831548098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE FARR P.A.

Provider Business Mailing Address
First Line	:	1548 E 4500 S
Second Line	:	STE 202
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1548 E 4500 S
Second Line	:	STE 202
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4209
Country	:	US
Telephone Number	:	801-266-8841
Fax Number	:

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

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/08/2016

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Directions to “ SHANE FARR P.A.” Practice Location

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