Healthcare Provider Details

I. General information

NPI: 1912225665
Provider Name (Legal Business Name): JAMIL TAHA EL-FARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S FLOYD ST STE 700
LOUISVILLE KY
40202-1845
US

IV. Provider business mailing address

601 SOUTH FLOYD STREET SUITE 700
LOUISVILLE KY
40202-4500
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-7181
  • Fax: 502-629-6957
Mailing address:
  • Phone: 502-629-7181
  • Fax: 502-629-6957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number23084
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number50660
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number52481
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: