Healthcare Provider Details

I. General information

NPI: 1659324291
Provider Name (Legal Business Name): THERESA SUE FARROW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E MONROE AVE
MCALESTER OK
74501-4815
US

IV. Provider business mailing address

1101 E MONROE AVE
MCALESTER OK
74501-4815
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-7800
  • Fax: 918-426-5526
Mailing address:
  • Phone: 318-426-7800
  • Fax: 918-426-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13404
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: