Provider Demographics
NPI:1396156360
Name:FARMER, WILLIAM ARTHUR (PA-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ARTHUR
Last Name:FARMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62707
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-2707
Mailing Address - Country:US
Mailing Address - Phone:239-931-3440
Mailing Address - Fax:
Practice Address - Street 1:1528 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3798
Practice Address - Country:US
Practice Address - Phone:239-458-3338
Practice Address - Fax:239-458-0666
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107832363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0R24OtherFLORIDA BLUE
FL015388300Medicaid
FLY0R24OtherFLORIDA BLUE