Provider Demographics
NPI:1053316083
Name:FARRIMOND, KENNETH LESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LESTER
Last Name:FARRIMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PARKLANE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1750
Mailing Address - Country:US
Mailing Address - Phone:210-771-3989
Mailing Address - Fax:210-826-8724
Practice Address - Street 1:210 PARKLANE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1750
Practice Address - Country:US
Practice Address - Phone:210-771-3989
Practice Address - Fax:210-826-8724
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4109174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0994204-02Medicaid
TX0994204-02Medicaid
TX00M374Medicare PIN