Provider Demographics
NPI:1386642924
Name:FARRELL, DANIEL RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RAYMOND
Last Name:FARRELL
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 1:12014 W BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-9261
Mailing Address - Country:US
Mailing Address - Phone:407-620-0211
Mailing Address - Fax:352-220-6463
Practice Address - Street 1:12014 W BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-9261
Practice Address - Country:US
Practice Address - Phone:407-620-0211
Practice Address - Fax:352-220-6463
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35807207Q00000X
FLME99257207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0297861Medicaid
IAI3309Medicare ID - Type UnspecifiedIOWA MEDICARE ID#
IA0297861Medicaid