Provider Demographics
NPI:1821173279
Name:FARRELL, DAVID S (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:FARRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14720 MAIN ST NE STE 109
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-8460
Mailing Address - Country:US
Mailing Address - Phone:425-788-4889
Mailing Address - Fax:425-844-6116
Practice Address - Street 1:14720 MAIN ST NE STE 109
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8460
Practice Address - Country:US
Practice Address - Phone:425-788-4889
Practice Address - Fax:425-844-6116
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOL20000112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine