Provider Demographics
NPI:1215116850
Name:FARRAH, JASON PAUL (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:FARRAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:920 DOUG WHITE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4181
Mailing Address - Country:US
Mailing Address - Phone:843-497-6348
Mailing Address - Fax:843-497-6351
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4550
Practice Address - Country:US
Practice Address - Phone:828-213-1994
Practice Address - Fax:828-213-1448
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2022-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME115864208600000X, 2086S0102X, 2086S0127X, 2086S0127X
SC527572086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910544Medicaid
NC5910544Medicaid
NCNC7369AMedicare PIN