Provider Demographics
NPI:1174612105
Name:FARMER, FREDRICK J III (DO)
Entity type:Individual
Prefix:
First Name:FREDRICK
Middle Name:J
Last Name:FARMER
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E 1ST
Mailing Address - Street 2:
Mailing Address - City:ST. JOHN
Mailing Address - State:KS
Mailing Address - Zip Code:67576
Mailing Address - Country:US
Mailing Address - Phone:620-549-3251
Mailing Address - Fax:855-332-0469
Practice Address - Street 1:609 E 1ST
Practice Address - Street 2:
Practice Address - City:ST. JOHN
Practice Address - State:KS
Practice Address - Zip Code:67576
Practice Address - Country:US
Practice Address - Phone:620-549-3251
Practice Address - Fax:855-332-0469
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0518773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100229660BMedicaid
KS103006OtherBLUE CROSS BLUE SHIELD
KS103006Medicare ID - Type UnspecifiedMEDICARE