Provider Demographics
NPI:1821068545
Name:FARMER, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:FARMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12670 CREEKSIDE LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8759
Mailing Address - Country:US
Mailing Address - Phone:239-482-2663
Mailing Address - Fax:239-482-7585
Practice Address - Street 1:12670 CREEKSIDE LANE
Practice Address - Street 2:SUITE 202
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8759
Practice Address - Country:US
Practice Address - Phone:239-482-2663
Practice Address - Fax:239-482-7585
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064459207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23326OtherBCBS
FL1821068545OtherCIGNA
FL250035300Medicaid
FLK0865Medicare ID - Type UnspecifiedMEDICARE GROUP
FL1821068545OtherCIGNA