Provider Demographics
NPI:1245422096
Name:FARRIS, ROBERT W JR (APRN,BC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:FARRIS
Suffix:JR
Gender:M
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S. 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:TX
Mailing Address - Zip Code:77962
Mailing Address - Country:US
Mailing Address - Phone:361-771-3311
Mailing Address - Fax:361-771-3081
Practice Address - Street 1:1013 S WELLS ST
Practice Address - Street 2:
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-4045
Practice Address - Country:US
Practice Address - Phone:361-782-7820
Practice Address - Fax:361-782-5627
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX594549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP58732Medicare UPIN