| Doctor Name: | DR. CHARLES DERRICK FARWELL |
| NPI Number: | 1811009079 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 9803 |
| Business Practice Address: | Naval Hospital, Camp Pendleton Sant Margarita Rd, Bldg H100; Attention: Code 094 Camp Pendleton, CA - 920555191 |
| Business Phone Number: | 7607258882 |
| Business Fax Number: | 7607251267 |
| Mailing Address: | 3376 Lockwood Dr, SAN DIEGO |
| State: | CA |
| Postal Code: | 921232618 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 9803 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |