Provider Demographics
NPI:1538117072
Name:FARRIS, GERARD EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:EDWARD
Last Name:FARRIS
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 1:8658 ARBOR OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3559
Mailing Address - Country:US
Mailing Address - Phone:704-786-4970
Mailing Address - Fax:704-786-4970
Practice Address - Street 1:8658 ARBOR OAKS CIR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3559
Practice Address - Country:US
Practice Address - Phone:704-786-4970
Practice Address - Fax:704-786-4970
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900213208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1206JOtherBCBS
SCQ00211Medicaid
NC891206JMedicaid
NC891206JMedicaid
NC2276203AMedicare PIN
930084341Medicare PIN