Basic Information
| Provider Information | |||||||||
| NPI: | 1720172190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARRER | ||||||||
| FirstName: | JULIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4705 MONTGOMERY BLVD NE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871091234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057277833 | ||||||||
| FaxNumber: | 5057276944 | ||||||||
| Practice Location | |||||||||
| Address1: | 4705 MONTGOMERY BLVD NE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871091234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057277833 | ||||||||
| FaxNumber: | 5057276944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 03/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 96208 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 96-208 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.