Provider Demographics
NPI:1568671204
Name:FARRIS, RORY COVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:RORY
Middle Name:COVETTE
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0729
Mailing Address - Country:US
Mailing Address - Phone:334-793-2663
Mailing Address - Fax:334-836-2247
Practice Address - Street 1:404 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2563
Practice Address - Country:US
Practice Address - Phone:334-308-9797
Practice Address - Fax:334-308-2909
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27062207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1568671204OtherMEDICARE ID
AL515-99807OtherBCBS OF AL - ENTERPRISE
AL511-30529OtherBCBS OF AL - HEALTHWEST
AL510-65889OtherBCBS OF AL - GENEVA
GA003129359AMedicaid
AL112803Medicaid
AL113687Medicaid