Healthcare Provider Details

I. General information

NPI: 1821173279
Provider Name (Legal Business Name): DAVID S FARRELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/07/2021
Certification Date: 03/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14720 MAIN ST NE STE 109
DUVALL WA
98019-8460
US

IV. Provider business mailing address

14720 MAIN ST NE STE 109
DUVALL WA
98019-8460
US

V. Phone/Fax

Practice location:
  • Phone: 425-788-4889
  • Fax: 425-844-6116
Mailing address:
  • Phone: 425-788-4889
  • Fax: 425-844-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOL20000112
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: