Provider Demographics
NPI:1831199173
Name:FARRELL, WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
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 1:800 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4664
Mailing Address - Country:US
Mailing Address - Phone:985-892-7621
Mailing Address - Fax:
Practice Address - Street 1:800 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 2C
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4664
Practice Address - Country:US
Practice Address - Phone:985-892-7621
Practice Address - Fax:985-819-1555
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12707207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1162311Medicaid
LAB63439Medicare UPIN
LA51879Medicare ID - Type Unspecified