Provider Demographics
NPI:1023306545
Name:KEVIN W FARRIS M.D., P.A.
Entity type:Organization
Organization Name:KEVIN W FARRIS M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-201-5483
Mailing Address - Street 1:1111 W FRANK AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3303
Mailing Address - Country:US
Mailing Address - Phone:936-632-7606
Mailing Address - Fax:936-632-1574
Practice Address - Street 1:1111 W FRANK AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3303
Practice Address - Country:US
Practice Address - Phone:936-632-7606
Practice Address - Fax:936-632-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty