Provider Demographics
NPI:1548358765
Name:FARRACH, HUSSEM ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:HUSSEM
Middle Name:ALEJANDRO
Last Name:FARRACH
Suffix:
Gender:M
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:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-8368
Mailing Address - Country:US
Mailing Address - Phone:405-745-9600
Mailing Address - Fax:405-745-9602
Practice Address - Street 1:901 N GALLOWAY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2493
Practice Address - Country:US
Practice Address - Phone:214-660-2580
Practice Address - Fax:405-745-9602
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP1457OtherMEDICAL LICENSE
TX314824901Medicaid
TX314824901Medicaid