Provider Demographics
NPI:1760492052
Name:FARNBERG, ERIC B (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:B
Last Name:FARNBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 1ST DR NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2941
Mailing Address - Country:US
Mailing Address - Phone:507-433-7351
Mailing Address - Fax:
Practice Address - Street 1:1000 1ST DR NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912
Practice Address - Country:US
Practice Address - Phone:507-433-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42502207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP59305OtherHEALTHPARTNERS NUMBER
TX1476665Medicaid
MN1023006OtherPREFERRED ONE NUMBER
MN127709OtherU-CARE NUMBER
MN11S27FAOtherBCBS NUMBER
MN006683400Medicaid
MN20-00235OtherMEDICA NUMBER
NE41091744413Medicaid
MNHP59305OtherHEALTHPARTNERS NUMBER
MN20-00235OtherMEDICA NUMBER
MN050001240Medicare ID - Type UnspecifiedMEDICARE NUMBER