Provider Demographics
NPI:1669482907
Name:FARRELL, STEVEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
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 1:1106 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2846
Mailing Address - Country:US
Mailing Address - Phone:601-261-9078
Mailing Address - Fax:
Practice Address - Street 1:1106 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2846
Practice Address - Country:US
Practice Address - Phone:601-261-9078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14920208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1419664Medicaid
MS640507572AROtherAMERICAN ADMIN GROUP
110122927OtherRAILROAD MEDICARE
MS000117297Medicaid
MS640507572AROtherAMERICAN ADMIN GROUP
LA1419664Medicaid