Provider Demographics
NPI:1336122076
Name:FARMER, CHAD ALTON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ALTON
Last Name:FARMER
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 1:400 MAHALANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2547
Mailing Address - Country:US
Mailing Address - Phone:808-800-1589
Mailing Address - Fax:
Practice Address - Street 1:400 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2547
Practice Address - Country:US
Practice Address - Phone:808-244-5555
Practice Address - Fax:808-244-5557
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90305207R00000X
HIMD-20547207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH61823Medicare UPIN
WI008N73601Medicare ID - Type Unspecified