Provider Demographics
NPI:1982642138
Name:FARLEY, GEORGE E (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:FARLEY
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 1:1894 HOLDENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-7061
Mailing Address - Country:US
Mailing Address - Phone:702-269-6822
Mailing Address - Fax:
Practice Address - Street 1:1894 HOLDENVILLE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-7061
Practice Address - Country:US
Practice Address - Phone:702-269-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE120652085N0904X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01438OtherBLUE CROSS BLUE SHIELD
KS100362890AMedicaid
IA0550863Medicaid
NE300113306OtherRR MEDICARE
NE272725Medicare PIN
NE01438OtherBLUE CROSS BLUE SHIELD