Provider Demographics
NPI:1609850528
Name:FARNES, LARRY D
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:FARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:D
Other - Last Name:FARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4007 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE C
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4330
Mailing Address - Country:US
Mailing Address - Phone:253-565-7529
Mailing Address - Fax:253-399-2508
Practice Address - Street 1:4007 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE C
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4330
Practice Address - Country:US
Practice Address - Phone:253-565-7529
Practice Address - Fax:253-399-2508
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000922174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB09726Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER