Healthcare Provider Details

I. General information

NPI: 1245433051
Provider Name (Legal Business Name): ROBERT JOSEPH FARRELL IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4359 NEW SHEPHERDSVILLE RD
BARDSTOWN KY
40004-8000
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 502-350-5492
  • Fax: 502-350-5495
Mailing address:
  • Phone: 606-330-7818
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2008-00427
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number42829
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: