Healthcare Provider Details

I. General information

NPI: 1952386476
Provider Name (Legal Business Name): ROBERT FARRELL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 NORTH HAMPTON ROAD
DESOTO TX
75115
US

IV. Provider business mailing address

815 PENNSYLVANIA AVE
FORT WORTH TX
76104-2224
US

V. Phone/Fax

Practice location:
  • Phone: 214-946-4397
  • Fax: 214-946-4399
Mailing address:
  • Phone: 817-321-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA10727900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD469781
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberH9920
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number67106
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-14203
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: