Provider Demographics
NPI:1740366244
Name:FARR, KENNETH D (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:FARR
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 1:10 WILLIAM POPE DRIVE
Mailing Address - Street 2:SUNGATE MEDICAL CENTER
Mailing Address - City:BLUFFON
Mailing Address - State:SC
Mailing Address - Zip Code:29909
Mailing Address - Country:US
Mailing Address - Phone:843-842-2020
Mailing Address - Fax:843-705-1512
Practice Address - Street 1:2020 W ILES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4174
Practice Address - Country:US
Practice Address - Phone:217-698-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16864207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003184541AMedicaid
GA003184541BMedicaid
SCGP6817OtherMEDICAID, GROUP
SCSC5426E499OtherMEDICARE PTAN
P01512723OtherRAILROAD MEDICARE
SC168641Medicaid
GA003184541BMedicaid
SC168641Medicaid