Provider Demographics
NPI:1811961113
Name:FARNWORTH, TODD K (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:K
Last Name:FARNWORTH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15801 S 37TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7325
Mailing Address - Country:US
Mailing Address - Phone:480-239-4799
Mailing Address - Fax:
Practice Address - Street 1:15810 S 45TH ST
Practice Address - Street 2:STE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7697
Practice Address - Country:US
Practice Address - Phone:480-759-3001
Practice Address - Fax:480-759-1341
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17174208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ294653Medicaid
AZE47589Medicare UPIN
AZ294653Medicaid