Provider Demographics
NPI:1851405393
Name:FARMER, GARY LEE (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:FARMER
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 1:1700 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-3711
Mailing Address - Country:US
Mailing Address - Phone:505-746-3531
Mailing Address - Fax:505-746-6958
Practice Address - Street 1:1700 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-3711
Practice Address - Country:US
Practice Address - Phone:505-746-3531
Practice Address - Fax:505-746-6958
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57892Medicare UPIN