Provider Demographics
NPI:1851397277
Name:FARLEY, DEREK A (DO)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:A
Last Name:FARLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 TOPAZ LN
Mailing Address - Street 2:
Mailing Address - City:OAK POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2274
Mailing Address - Country:US
Mailing Address - Phone:972-292-3911
Mailing Address - Fax:972-292-3911
Practice Address - Street 1:931 TOPAZ LN
Practice Address - Street 2:
Practice Address - City:OAK POINT
Practice Address - State:TX
Practice Address - Zip Code:75068-2274
Practice Address - Country:US
Practice Address - Phone:972-292-3911
Practice Address - Fax:972-292-3911
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125658807Medicaid
TX125658807Medicaid
TXG83970Medicare UPIN