Provider Demographics
NPI:1962517284
Name:FARBER, GERALD LAVON (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:LAVON
Last Name:FARBER
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:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-640-2790
Mailing Address - Fax:432-640-4723
Practice Address - Street 1:8050 E HIGHWAY 191 STE 210
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8615
Practice Address - Country:US
Practice Address - Phone:432-640-2790
Practice Address - Fax:432-640-4723
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8664207XS0106X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331144101Medicaid
TX331144101Medicaid