Provider Demographics
NPI:1588639827
Name:FARRELL, CURTISS D (MD)
Entity Type:Individual
Prefix:
First Name:CURTISS
Middle Name:D
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 1:1301 E LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7300
Mailing Address - Country:US
Mailing Address - Phone:580-208-3100
Mailing Address - Fax:580-208-3199
Practice Address - Street 1:510 S PARK DR
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-5330
Practice Address - Country:US
Practice Address - Phone:580-584-3449
Practice Address - Fax:580-584-3451
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3610207Q00000X
IA24227207Q00000X
NE16686207Q00000X
OK28872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2570OtherMIDLANDS CHOICE
NE31047OtherBCBS
NE096938001Medicare PIN
NE2570OtherMIDLANDS CHOICE