Provider Demographics
NPI:1457322513
Name:FARMER, KANDACE B (DO)
Entity Type:Individual
Prefix:DR
First Name:KANDACE
Middle Name:B
Last Name:FARMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 WINDSOR CENTRE TRAIL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1557
Mailing Address - Country:US
Mailing Address - Phone:972-316-4448
Mailing Address - Fax:
Practice Address - Street 1:4320 WINDSOR CENTRE TRAIL
Practice Address - Street 2:SUITE 300
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1557
Practice Address - Country:US
Practice Address - Phone:972-316-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM57022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186197302Medicaid
TX186197301Medicaid
TX186197302Medicaid
SCT00121Medicare ID - Type Unspecified
TX186197301Medicaid
TX8J4927Medicare PIN
TXP00405444Medicare PIN
TX8J4926Medicare PIN