Provider Demographics
NPI:1821313271
Name:DANNY M FARMER MD PA
Entity Type:Organization
Organization Name:DANNY M FARMER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-676-3959
Mailing Address - Street 1:570 MEMORIAL CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5002
Mailing Address - Country:US
Mailing Address - Phone:386-676-3959
Mailing Address - Fax:386-677-0514
Practice Address - Street 1:570 MEMORIAL CIR
Practice Address - Street 2:SUITE 110
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5002
Practice Address - Country:US
Practice Address - Phone:386-676-3959
Practice Address - Fax:386-677-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042997000Medicaid
FL110229973OtherRAILROAD MEDICARE
FL042997000Medicaid
FL59962Medicare PIN