Provider Demographics
NPI:1255338331
Name:FARRELL, CATHY L (MD)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:FARRELL
Suffix:
Gender:F
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:BOND CLINIC, P.A.
Mailing Address - Street 2:500 EAST CENTRAL AVENUE
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880
Mailing Address - Country:US
Mailing Address - Phone:863-293-1191
Mailing Address - Fax:863-293-3635
Practice Address - Street 1:BOND CLINIC, P.A.
Practice Address - Street 2:500 EAST CENTRAL AVENUE
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880
Practice Address - Country:US
Practice Address - Phone:863-293-1191
Practice Address - Fax:863-293-3635
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 56704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG65039Medicare UPIN
FL41585Medicare ID - Type Unspecified