Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 45201 | KY |
Y | 2080P0205X | Pediatric Endocrinologist | 35-121396 | OH |
NPI | 1033351481 |
---|---|
Provider Name | Ryan Michael Farrell |
First Address | Highland Hills, OH 44122-7251 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 01/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201073330 | (05) | IN |