Provider Demographics
NPI:1154426997
Name:FARRIS, PAUL ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALEXANDER
Last Name:FARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 HWY 36 W.
Mailing Address - Street 2:STE. 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3905
Mailing Address - Country:US
Mailing Address - Phone:651-292-2000
Mailing Address - Fax:651-292-2176
Practice Address - Street 1:2355 HWY 36 W.
Practice Address - Street 2:STE. 100
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3905
Practice Address - Country:US
Practice Address - Phone:651-292-2000
Practice Address - Fax:651-292-2176
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD600821332085R0202X
MN617472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA342146OtherLNI-TRA KING COUNTY
WA342138OtherLNI-UAOM
WA342141OtherLNI-TRA REST OF WA
WA2000894Medicaid
WA343212OtherLNI-MIO1
WA342138OtherLNI-UAOM
WAG8960174Medicare PIN
WAG8960173Medicare PIN
WAP01766326Medicare PIN
WAG8942519Medicare PIN
WAG8942659Medicare PIN
WA2000894Medicaid
WAG8960176Medicare PIN
WAG8942526Medicare PIN
WA342146OtherLNI-TRA KING COUNTY