Individual
DR. KENNETH D FARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2020 W ILES AVE, SPRINGFIELD, IL 62704-4174
(217) 698-3030
Mailing address
10 WILLIAM POPE DRIVE, SUNGATE MEDICAL CENTER, BLUFFON, SC 29909
(843) 842-2020
(843) 705-1512
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
16864
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003184541A
—
GA
05
—
003184541B
—
GA
05
—
168641
—
SC
01
—
GP6817
MEDICAID, GROUP
SC
01
—
P01512723
RAILROAD MEDICARE
—
01
—
SC5426E499
MEDICARE PTAN
SC
Enumeration date
10/27/2006
Last updated
04/06/2023
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