Provider Demographics
NPI:1366798563
Name:FARKAS, WILLIAM GARY VINCENT (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GARY VINCENT
Last Name:FARKAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-7879
Mailing Address - Fax:864-512-7037
Practice Address - Street 1:21 S SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:HONEA PATH
Practice Address - State:SC
Practice Address - Zip Code:29654-1503
Practice Address - Country:US
Practice Address - Phone:864-512-7879
Practice Address - Fax:864-512-7037
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC83060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program