Provider Demographics
NPI:1598777583
Name:FARLEY, PHILIP LYNN (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:LYNN
Last Name:FARLEY
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 1:909 FROSTWOOD DR
Mailing Address - Street 2:STE. 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:713-338-5500
Practice Address - Street 1:9813 MEMORIAL BLVD
Practice Address - Street 2:STE A
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4274
Practice Address - Country:US
Practice Address - Phone:281-913-3550
Practice Address - Fax:281-913-3552
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG81002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098273803Medicaid
TX098273803Medicaid
TXP00011703Medicare PIN
TX8760K7Medicare PIN