Basic Information
| Provider Information | |||||||||
| NPI: | 1770508905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARNUM | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MARJORIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 REPUBLIC PKWY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751506917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722797575 | ||||||||
| FaxNumber: | 9722700197 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 REPUBLIC PKWY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751506917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722797575 | ||||||||
| FaxNumber: | 9722700197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | H5309 | TX | X | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | H5309 | TX | X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.