MEDICARE: DR. FREDERIC ORVILLE FARRELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	F9410	TX

General Provider Information

NPI Number	:	1235204025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERIC ORVILLE FARRELL M.D.

Provider Business Mailing Address
First Line	:	5 BARCELONA CT
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-3902
Country	:	US
Telephone Number	:	940-691-4937
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 BARCELONA CT
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-3902
Country	:	US
Telephone Number	:	940-691-4937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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