Provider Demographics
NPI:1538237391
Name:FARRAGE, JAMES ROBERT JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:FARRAGE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 MCINTOSH ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1037
Mailing Address - Country:US
Mailing Address - Phone:270-782-9617
Mailing Address - Fax:
Practice Address - Street 1:1725 MCINTOSH ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1037
Practice Address - Country:US
Practice Address - Phone:270-793-9229
Practice Address - Fax:270-793-9076
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17821208100000X
KY29032208100000X
TNMD0000025621208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1503324OtherUMWA
KY250005571OtherRR MEDICARE
KY64290323Medicaid
KY000000197276OtherANTHEM BCBS
KY1135464OtherPASSPORT MEDICAID
KY8145OtherKENTUCKY WC
KY1135464OtherPASSPORT MEDICAID
KY250005571OtherRR MEDICARE