Provider Demographics
NPI:1366011264
Name:FARRAR, BLAKE HOUSTON (DO)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:HOUSTON
Last Name:FARRAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981225 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-1225
Mailing Address - Country:US
Mailing Address - Phone:402-559-7775
Mailing Address - Fax:402-559-8940
Practice Address - Street 1:981225 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1225
Practice Address - Country:US
Practice Address - Phone:402-836-9288
Practice Address - Fax:402-559-8228
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program