Provider Demographics
NPI:1477535912
Name:FARLEY, SCOTT ANDREW (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREW
Last Name:FARLEY
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 1:18601 LBJ FWY STE 618
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5615
Mailing Address - Country:US
Mailing Address - Phone:214-782-9222
Mailing Address - Fax:214-782-9333
Practice Address - Street 1:18601 LBJ FWY STE 618
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5615
Practice Address - Country:US
Practice Address - Phone:214-782-9222
Practice Address - Fax:214-782-9333
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9514207X00000X, 207XS0117X
OK4451207X00000X, 207XS0117X
TXM5154207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I34440Medicare UPIN