Provider Demographics
NPI:1952491052
Name:FARRELL, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:FARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 BLOSSOM ST STE G
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4200
Mailing Address - Country:US
Mailing Address - Phone:281-316-0331
Mailing Address - Fax:281-316-0200
Practice Address - Street 1:450 BLOSSOM ST STE G
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4200
Practice Address - Country:US
Practice Address - Phone:281-316-0331
Practice Address - Fax:281-316-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2697207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122242403OtherMEDICAID TPI
TX20014OtherHERITAGE
TXS01503OtherBLUE LINK
TXTXB165524OtherBLUE CROSS BLUE SHIELD
TXTXB165524OtherHMO BLUE
TX926228OtherAETNA
TX10013103OtherAMERIGROUP
TX122242403Medicaid
TXP00049BP8Medicaid
TXTXB165524OtherBLUE CROSS BLUE SHIELD
TXP00049BP8Medicaid