Individual
ETHAN PAUL FARMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2651 E DISCOVERY PKWY, BLOOMINGTON, IN 47408-9059
(812) 353-9515
(812) 353-9275
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02007076A
IN
207P00000X
Emergency Medicine Physician
LL83262
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540878
MEDICARE PTAN
IN
05
—
300078879
—
IN
Enumeration date
06/24/2020
Last updated
10/10/2023
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