Provider Demographics
NPI:1174614622
Name:FARRELL, ESTELLE R (DO)
Entity type:Individual
Prefix:DR
First Name:ESTELLE
Middle Name:R
Last Name:FARRELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ESTELLE
Other - Middle Name:
Other - Last Name:FARRELL-NIERENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:13835 N TATUM BLVD STE 9236
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-0405
Mailing Address - Country:US
Mailing Address - Phone:480-209-4554
Mailing Address - Fax:844-287-5554
Practice Address - Street 1:4921 E BELL RD STE 203
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6002
Practice Address - Country:US
Practice Address - Phone:480-955-1515
Practice Address - Fax:844-287-5554
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3223208VP0000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ449216Medicaid
AZZ189079Medicare PIN
AZ449216Medicaid