MEDICARE: HAILEY C FARRIS 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	207Q00000X	Family Medicine Physician	E9214	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447514310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY C FARRIS M.D.

Provider Business Mailing Address
First Line	:	200 N 3RD ST
Second Line	:
City	:	DARDANELLE
State	:	AR
Zip	:	72834-3802
Country	:	US
Telephone Number	:	479-229-6191
Fax Number	:	479-229-6194

Provider Business Practice Location Address
First Line	:	200 N 3RD ST
Second Line	:
City	:	DARDANELLE
State	:	AR
Zip	:	72834-3802
Country	:	US
Telephone Number	:	479-229-6191
Fax Number	:	479-229-6194

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

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	01/23/2022

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Directions to “ HAILEY C FARRIS M.D.” Practice Location

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