Provider Demographics
NPI: | 1891942637 |
---|---|
Name: | RICHARD F FARAH MD PC |
Entity Type: | Organization |
Organization Name: | RICHARD F FARAH MD PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER / PRES |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RICHARD |
Authorized Official - Middle Name: | F |
Authorized Official - Last Name: | FARAH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 907-770-2301 |
Mailing Address - Street 1: | 4141 B ST |
Mailing Address - Street 2: | SUITE 401 |
Mailing Address - City: | ANCHORAGE |
Mailing Address - State: | AK |
Mailing Address - Zip Code: | 99503-5940 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 907-770-2301 |
Mailing Address - Fax: | 907-770-2325 |
Practice Address - Street 1: | 4141 B ST |
Practice Address - Street 2: | SUITE 401 |
Practice Address - City: | ANCHORAGE |
Practice Address - State: | AK |
Practice Address - Zip Code: | 99503-5940 |
Practice Address - Country: | US |
Practice Address - Phone: | 907-770-2301 |
Practice Address - Fax: | 907-770-2325 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-08-22 |
Last Update Date: | 2008-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AK | 2483 | 208600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Single Specialty |