Healthcare Provider Details

I. General information

NPI: 1144725458
Provider Name (Legal Business Name): SEAN MICHAEL FARRELL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S GLOSTER ST STE A
TUPELO MS
38801-6548
US

IV. Provider business mailing address

1211 S GLOSTER ST STE A
TUPELO MS
38801-6548
US

V. Phone/Fax

Practice location:
  • Phone: 662-767-4200
  • Fax:
Mailing address:
  • Phone: 662-767-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number33411
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: