Provider Demographics
NPI:1366513624
Name:FARMER, LESLIE R (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:R
Last Name:FARMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5025 J ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3839
Mailing Address - Country:US
Mailing Address - Phone:916-451-6590
Mailing Address - Fax:916-451-6024
Practice Address - Street 1:5025 J ST
Practice Address - Street 2:SUITE 311
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3839
Practice Address - Country:US
Practice Address - Phone:916-451-6590
Practice Address - Fax:916-451-6024
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089050Medicaid
CAZZZ18889ZMedicare ID - Type UnspecifiedGROUP MEDICARE
CAGR0089050Medicaid