Provider Demographics
NPI:1689769085
Name:FARRAR, J RANDALL (MD)
Entity Type:Individual
Prefix:MR
First Name:J
Middle Name:RANDALL
Last Name:FARRAR
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:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-0160
Mailing Address - Country:US
Mailing Address - Phone:509-946-1004
Mailing Address - Fax:
Practice Address - Street 1:1215 GEORGE WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3442
Practice Address - Country:US
Practice Address - Phone:509-946-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031441207RC0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11014944OtherRAIL ROAD MEDICARE
WA1101799Medicaid
WA154834286OtherGROUP HEALTH
WA1101799Medicaid