Basic Information
Provider Information
NPI: 1003003963
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FARAHANI
FirstName: CYRUS
MiddleName: RICHARD
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6300 LA CALMA DR
Address2: SUITE 200
City: AUSTIN
State: TX
PostalCode: 787523843
CountryCode: US
TelephoneNumber: 5124528533
FaxNumber:  
Practice Location
Address1: 800 E HIGHWAY 71
Address2:  
City: SMITHVILLE
State: TX
PostalCode: 789571730
CountryCode: US
TelephoneNumber: 5122373214
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/25/2007
LastUpdateDate: 08/23/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XN0013TXY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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