Provider Demographics
NPI:1275735086
Name:DUSKY R. FARMER, DPM, LLC
Entity Type:Organization
Organization Name:DUSKY R. FARMER, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSKY
Authorized Official - Middle Name:RIDEOUT
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-421-8555
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000944A213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20085820Medicaid
IN234240Medicare PIN
IN5633450001Medicare NSC
IN20085820Medicaid