Provider Demographics
NPI:1710978655
Name:FARRIS, KELLY EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:EDWIN
Last Name:FARRIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 W WHEATLAND RD
Mailing Address - Street 2:PAV III STE#360
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4408
Mailing Address - Country:US
Mailing Address - Phone:214-884-4700
Mailing Address - Fax:214-884-4762
Practice Address - Street 1:170 EAST FM 544
Practice Address - Street 2:SUITE 112
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4080
Practice Address - Country:US
Practice Address - Phone:972-722-6600
Practice Address - Fax:972-722-6601
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-10-06
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Provider Licenses
StateLicense IDTaxonomies
TXK8143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047500601Medicaid
TXG96117Medicare UPIN
TX047500601Medicaid