Provider Demographics
NPI:1730204181
Name:FARRAR, RAYMOND J
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:FARRAR
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:J
Other - Last Name:FARRAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:29840 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2608
Mailing Address - Country:US
Mailing Address - Phone:586-294-7250
Mailing Address - Fax:586-294-7251
Practice Address - Street 1:29840 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2608
Practice Address - Country:US
Practice Address - Phone:586-294-7250
Practice Address - Fax:586-294-7251
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0591213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery