Provider Demographics
NPI:1467040220
Name:MAC FARLANE, DYLAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:MAC FARLANE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:DYLAN
Other - Middle Name:
Other - Last Name:MAC FARLANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1201 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1016
Mailing Address - Country:US
Mailing Address - Phone:828-620-4700
Mailing Address - Fax:
Practice Address - Street 1:3125 HICKORY ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1219
Practice Address - Country:US
Practice Address - Phone:828-620-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program