Provider Demographics
NPI:1285703454
Name:FARMER, JOHN MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MITCHELL
Last Name:FARMER
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 1:512 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4205
Mailing Address - Country:US
Mailing Address - Phone:502-894-0266
Mailing Address - Fax:502-894-0737
Practice Address - Street 1:512 EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4205
Practice Address - Country:US
Practice Address - Phone:502-894-0266
Practice Address - Fax:502-894-0737
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYXF76785212083A0300X
KY19060207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64190606Medicaid
KYC74168Medicare UPIN
KY1782301Medicare ID - Type Unspecified