Provider Demographics
NPI:1407029150
Name:FARAIL, P.A.
Entity Type:Organization
Organization Name:FARAIL, P.A.
Other - Org Name:KERRVILLE VACCINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-895-7606
Mailing Address - Street 1:208 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5809
Mailing Address - Country:US
Mailing Address - Phone:830-895-7606
Mailing Address - Fax:830-257-0878
Practice Address - Street 1:208 WESLEY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5809
Practice Address - Country:US
Practice Address - Phone:830-895-7606
Practice Address - Fax:830-257-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE25312083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty