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General NPI Number Information
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NPI Number | 1023306545
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Entity Type | Organization
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Legal Business Name | KEVIN W FARRIS M.D., P.A.
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 1111 W FRANK AVE SUITE 301
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City | LUFKIN
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State | TX
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Zip | 75904-3303
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Country | US
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Telephone | 936-632-7606
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Fax | 936-632-1574
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Provider Business Mailing Address
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Address Line | 1111 W FRANK AVE SUITE 301
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City | LUFKIN
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State | TX
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Zip | 75904-3303
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Country | US
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Telephone | 936-632-7606
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Fax | 936-632-1574
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN WAYNE FARRIS
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Credential | M.D.
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Telephone | 713-201-5483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M7965
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License Number State | TX
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