Provider Demographics
NPI:1831159102
Name:TUMBACO, FARLEY K (MD)
Entity type:Individual
Prefix:DR
First Name:FARLEY
Middle Name:K
Last Name:TUMBACO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 MONROE HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4294
Mailing Address - Country:US
Mailing Address - Phone:318-640-3737
Mailing Address - Fax:318-640-3740
Practice Address - Street 1:3200 MONROE HWY STE 150
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4294
Practice Address - Country:US
Practice Address - Phone:318-640-3737
Practice Address - Fax:318-640-3740
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09946 R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00419417OtherRAILROAD MEDICARE
LA1967742Medicaid
F60414Medicare UPIN
5R745Medicare PIN