Healthcare Provider Details

I. General information

NPI: 1386642924
Provider Name (Legal Business Name): DANIEL RAYMOND FARRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 E HIGHWAY 98
PORT ST JOE FL
32456-5318
US

IV. Provider business mailing address

1601 CUMMINS DR STE D
MODESTO CA
95358-6411
US

V. Phone/Fax

Practice location:
  • Phone: 806-853-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax: 352-220-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35807
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME99257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: