Provider Demographics
NPI:1942398110
Name:FARLING, JACK D (PA-C)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:D
Last Name:FARLING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6307
Mailing Address - Country:US
Mailing Address - Phone:740-387-3256
Mailing Address - Fax:740-383-4906
Practice Address - Street 1:241 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6307
Practice Address - Country:US
Practice Address - Phone:740-387-3256
Practice Address - Fax:740-383-4906
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000262363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091779Medicaid
OH0091779Medicaid