Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | K7282 | TX |
NPI | 1073593745 |
---|---|
Provider Name | Dr. Douglas R Farris |
First Address | Hurst, TX 76054-3131 |
Second Address | Hurst, TX 76054-3131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G97497 | (02) | TX |