Provider Demographics
NPI:1114904935
Name:FARMER, DUSKY RIDEOUT (DPM)
Entity Type:Individual
Prefix:DR
First Name:DUSKY
Middle Name:RIDEOUT
Last Name:FARMER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 UPPER MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-6421
Mailing Address - Country:US
Mailing Address - Phone:812-421-8555
Mailing Address - Fax:812-402-2139
Practice Address - Street 1:4501 UPPER MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6421
Practice Address - Country:US
Practice Address - Phone:812-421-8555
Practice Address - Fax:812-402-2139
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000944A213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200805820Medicaid
IN20085820Medicaid
IN200805820Medicaid
IN234240Medicare PIN
INU93124Medicare UPIN