Provider Demographics
NPI:1124350301
Name:ED FARROW MD PC
Entity type:Organization
Organization Name:ED FARROW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FARROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-689-7705
Mailing Address - Street 1:218 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-1633
Mailing Address - Country:US
Mailing Address - Phone:918-689-7705
Mailing Address - Fax:918-689-3889
Practice Address - Street 1:218 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-1633
Practice Address - Country:US
Practice Address - Phone:918-689-7705
Practice Address - Fax:918-689-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13179261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care