Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0101266361 | VA |
NPI | 1043742570 |
---|---|
Provider Name | Dr. Samuel Farrell |
First Address | San Antonio, TX 78234-4504 |
Second Address | San Antonio, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 09/05/2019 |