Provider Demographics
NPI:1831379445
Name:FARR, PETER DONALD (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:DONALD
Last Name:FARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10967 ALLISONVILLE RD
Mailing Address - Street 2:110
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2632
Mailing Address - Country:US
Mailing Address - Phone:317-559-7970
Mailing Address - Fax:317-559-7971
Practice Address - Street 1:10967 ALLISONVILLE RD
Practice Address - Street 2:110
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2632
Practice Address - Country:US
Practice Address - Phone:317-559-7970
Practice Address - Fax:317-559-7971
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036562A207QA0401X, 208D00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN170270FOtherMEDICARE
IN100090810Medicaid
IN1831379445OtherNPI
IN172580NNMedicare PIN