Provider Demographics
NPI:1073625505
Name:FARBER, GEORGE ALLAN SR (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ALLAN
Last Name:FARBER
Suffix:SR
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 1:3705 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3031
Mailing Address - Country:US
Mailing Address - Phone:504-471-3100
Mailing Address - Fax:504-471-3109
Practice Address - Street 1:3705 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3031
Practice Address - Country:US
Practice Address - Phone:504-471-3100
Practice Address - Fax:504-471-3109
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8634207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1115037Medicaid
LA1115037Medicaid
LA51911Medicare ID - Type Unspecified