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Organization

SUNGATE DERMATOLOGY

Active
Parent organization
PALMETTO EYE SPECIALISTS PA
Organization subpart
Yes

Provider details

NPI number
Legal business name
PALMETTO EYE SPECIALISTS PA
Authorized official
DR. KENNETH DANIEL FARR M.D. (MEDICAL DIRECTOR)
(843) 842-2020
Entity
Organization

Contact information

Practice address
10 WILLIAM POPE DR, SUNGATE MEDICAL CENTER, SUITE #4, BLUFFTON, SC 29909-7549
(843) 705-1513
(843) 705-1514
Mailing address
10 WILLIAM POPE DR, SUNGATE MEDICAL CENTER, SUITE #4, BLUFFTON, SC 29909-7549
(843) 705-1513
(843) 705-1514

Taxonomy

Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
MD31744
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6830
MEDICARE
SC
01
CH3121
RAILROAD MEDICARE
SC
05
GP2666
SC
01
P00764908
MEDICARE GROUP PTAN
SC
Enumeration date
04/30/2013
Last updated
04/30/2013
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