Basic Information
| Provider Information | |||||||||
| NPI: | 1215116850 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARRAH | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 DOUG WHITE DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295724181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434976348 | ||||||||
| FaxNumber: | 8434976351 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282131994 | ||||||||
| FaxNumber: | 8282131448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2007 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME115864 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | ME115864 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 52757 | SC | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | ME115864 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 208600000X | 52757 | SC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5910544 | 05 | NC | MEDICAID |