Provider Demographics
NPI:1629003785
Name:FARMER, DANNY M (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:M
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 1:570 MEMORIAL CIRCLE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-676-3959
Mailing Address - Fax:386-677-0514
Practice Address - Street 1:570 MEMORIAL CIRCLE
Practice Address - Street 2:SUITE 110
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-676-3959
Practice Address - Fax:386-677-0514
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042997000Medicaid
FL592863130OtherUNITED HEALTHCARE
FL110229973OtherRAILROAD MEDICARE
FL592863130OtherUNITED HEALTHCARE
FL042997000Medicaid