Provider Demographics
NPI:1801853890
Name:FARNHAM, JOHN CRAIG (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CRAIG
Last Name:FARNHAM
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 1:12618 N 84TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5317
Mailing Address - Country:US
Mailing Address - Phone:480-227-4479
Mailing Address - Fax:
Practice Address - Street 1:13943 N 91ST AVE STE A102
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3688
Practice Address - Country:US
Practice Address - Phone:623-344-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE44444Medicare UPIN