Provider Demographics
NPI:1598754608
Name:FARROW, DEMETRIOUS (PA-C)
Entity Type:Individual
Prefix:
First Name:DEMETRIOUS
Middle Name:
Last Name:FARROW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 W MEMORIAL RD
Mailing Address - Street 2:STE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9322
Mailing Address - Country:US
Mailing Address - Phone:405-748-3300
Mailing Address - Fax:405-748-2920
Practice Address - Street 1:4120 W MEMORIAL RD
Practice Address - Street 2:STE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9322
Practice Address - Country:US
Practice Address - Phone:405-748-3300
Practice Address - Fax:405-748-2920
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1249363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200019520AMedicaid
243405802Medicare ID - Type Unspecified
P77620Medicare UPIN