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General NPI Number Information
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NPI Number | 1770739419
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Entity Type | Organization
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Legal Business Name | JOHN S. FARRELL, M.D., P.C.
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 621 S NEW BALLAS RD SUITE 584A
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8232
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Country | US
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Telephone | 314-251-6966
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Fax | 314-251-6632
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Provider Business Mailing Address
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Address Line | 621 S NEW BALLAS RD SUITE 584A
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8232
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Country | US
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Telephone | 314-251-6966
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Fax | 314-251-6632
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN S FARRELL
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Credential | M.D.
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Telephone | 314-251-6966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | R5636
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License Number State | MO
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