Provider Demographics
NPI:1740238849
Name:FARRELL, PATRICK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:EDWARD
Last Name:FARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DR
Other - Middle Name:
Other - Last Name:FARRELL, LLC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:967 E PARKCENTER BLVD
Mailing Address - Street 2:# 273
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6721
Mailing Address - Country:US
Mailing Address - Phone:208-955-8215
Mailing Address - Fax:208-445-5899
Practice Address - Street 1:301 W MYRTLE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7656
Practice Address - Country:US
Practice Address - Phone:208-955-8215
Practice Address - Fax:208-445-5899
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6441208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003692900Medicaid
ID000010158339OtherBLUE SHIELD OF IDAHO
ID76755OtherBLUE CROSS OF IDAHO
ID003692900Medicaid
ID11298111Medicare PIN