Provider Demographics
NPI:1043359920
Name:FARRER, RANDALL (PA-C)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:FARRER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 HORIZON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7815
Mailing Address - Country:US
Mailing Address - Phone:817-442-9300
Mailing Address - Fax:
Practice Address - Street 1:3142 HORIZON RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7815
Practice Address - Country:US
Practice Address - Phone:817-442-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 03227363A00000X
TXPA03227363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant