Provider Demographics
NPI:1558698167
Name:FARAR, DALLIN ORIN (PA)
Entity Type:Individual
Prefix:
First Name:DALLIN
Middle Name:ORIN
Last Name:FARAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 S RIDGEVIEW DR
Mailing Address - Street 2:STE 300
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8866
Mailing Address - Country:US
Mailing Address - Phone:928-329-4771
Mailing Address - Fax:928-329-4886
Practice Address - Street 1:2377 S 22ND DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8865
Practice Address - Country:US
Practice Address - Phone:928-343-0488
Practice Address - Fax:928-782-0401
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4527363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ134492Medicare PIN