Provider Demographics
NPI:1245201409
Name:FAREK, PAUL E (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:FAREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 ELIZABETH
Mailing Address - Street 2:STE 811
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404
Mailing Address - Country:US
Mailing Address - Phone:361-882-1245
Mailing Address - Fax:361-882-1246
Practice Address - Street 1:613 ELIZABETH
Practice Address - Street 2:STE 811
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404
Practice Address - Country:US
Practice Address - Phone:361-882-1245
Practice Address - Fax:361-882-1246
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3345208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136733607Medicaid
C15566Medicare UPIN
0K01XMedicare ID - Type Unspecified