Provider Demographics
NPI:1831176601
Name:FARISH, KENT G (MD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:G
Last Name:FARISH
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 1:2834 E 26TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-4310
Mailing Address - Country:US
Mailing Address - Phone:918-406-5139
Mailing Address - Fax:
Practice Address - Street 1:940 E 36TH ST N
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1953
Practice Address - Country:US
Practice Address - Phone:918-663-6228
Practice Address - Fax:918-665-0925
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34623Medicare UPIN