Basic Information
| Provider Information | |||||||||
| NPI: | 1588639827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARRELL | ||||||||
| FirstName: | CURTISS | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 E LINCOLN RD | ||||||||
| Address2: | |||||||||
| City: | IDABEL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747457300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802083100 | ||||||||
| FaxNumber: | 5802083199 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 S PARK DR | ||||||||
| Address2: | |||||||||
| City: | BROKEN BOW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747285330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5805843449 | ||||||||
| FaxNumber: | 5805843451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 07/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3610 | SD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 24227 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 16686 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 28872 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2570 | 01 | NE | MIDLANDS CHOICE | OTHER | 31047 | 01 | NE | BCBS | OTHER |