Individual
MR. GLEN S FARRIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
207 E COURT ST, NEWTON, TX 75966-3203
(409) 379-2647
(409) 379-2698
Mailing address
RR 1 BOX 42, JASPER, TX 75951-9801
(409) 384-8089
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00499
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0083GN
BCBS GROUP
—
Enumeration date
02/27/2006
Last updated
07/09/2007
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