Provider Demographics
NPI:1427097575
Name:FARRAR, CYNTHIA DAWN (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:DAWN
Last Name:FARRAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 S BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-1534
Mailing Address - Country:US
Mailing Address - Phone:800-952-8387
Mailing Address - Fax:913-946-1699
Practice Address - Street 1:3302 S BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-1534
Practice Address - Country:US
Practice Address - Phone:800-952-8387
Practice Address - Fax:913-946-1699
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108380207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208482117Medicaid
MO108380OtherSTATE MEDICAL LICENSE
MO20411OtherBNDD
MO080191162OtherRR MEDICARE
MO080191162OtherRR MEDICARE
MO108380OtherSTATE MEDICAL LICENSE
MOG37194Medicare UPIN