Provider Demographics
NPI:1033116322
Name:FARR, ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:FARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 W IRONWOOD DR
Mailing Address - Street 2:STE 236
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4484
Mailing Address - Country:US
Mailing Address - Phone:208-765-1345
Mailing Address - Fax:208-667-9622
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:STE 236
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4484
Practice Address - Country:US
Practice Address - Phone:208-765-1345
Practice Address - Fax:208-667-9622
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5806207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0083130Medicaid
WA8409252Medicaid
000010006074OtherREGENCE BLUE SHIELD OF ID
58065OtherBLUE CROSS OF IDAHO
E92522Medicare UPIN
WA8409252Medicaid