Provider Demographics
NPI:1770528085
Name:FARR, WALTER
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:FARR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 PLAZA BLANCA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5340
Mailing Address - Country:US
Mailing Address - Phone:505-438-4448
Mailing Address - Fax:
Practice Address - Street 1:2940 PLAZA BLANCA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-5340
Practice Address - Country:US
Practice Address - Phone:505-438-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-05362084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C15576Medicare UPIN
8HZ449Medicare ID - Type Unspecified