Basic Information
| Provider Information | |||||||||
| NPI: | 1396156360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ARTHUR | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62707 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339062707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399313440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1528 DEL PRADO BLVD S | ||||||||
| Address2: | |||||||||
| City: | CAPE CORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339903798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394583338 | ||||||||
| FaxNumber: | 2394580666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2014 | ||||||||
| LastUpdateDate: | 12/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9107832 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | Y0R24 | 01 | FL | FLORIDA BLUE | OTHER | 015388300 | 05 | FL | MEDICAID |