Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 60789 | KS |
NPI | 1033311733 |
---|---|
Provider Name | Dr. Brendan Timothy Farrell |
First Address | Lawrence, KS 66044-1359 |
Second Address | Lawrence, KS 66044-1359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 12/02/2014 |