Provider Demographics
NPI:1134399264
Name:FARRELL, ROY GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:GEORGE
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:TUCSON VETERANS ADMINISTRATION HOSPITAL EMERGENCY DEPT
Mailing Address - Street 2:3601 S. 6TH AVE
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85723-0001
Mailing Address - Country:US
Mailing Address - Phone:520-629-4950
Mailing Address - Fax:520-629-1734
Practice Address - Street 1:TUCSON VETERANS ADMINISTRATION HOSPITAL EMERGENCY DEPT
Practice Address - Street 2:3601 S. 6TH AVE
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-629-4950
Practice Address - Fax:520-629-1734
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013193207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8464323Medicaid
WA8464323Medicaid