Individual
DR. FRED W. FARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3231 S NATIONAL AVE, SPRINGFIELD, MO 65807-7304
(417) 888-5658
(417) 841-0104
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2002016474
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110237766
RAILROAD MEDICARE
—
05
—
205880602
—
MO
01
—
431560263021
TRICARE
—
Enumeration date
12/04/2006
Last updated
10/02/2014
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