Healthcare Provider Details

I. General information

NPI: 1265056147
Provider Name (Legal Business Name): JACOB MATTHEW FARRAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 HIGHWAY 17 UNIT 200
MURRELLS INLET SC
29576-5113
US

IV. Provider business mailing address

210 VILLAGE CENTER BLVD STE 140
MYRTLE BEACH SC
29579-6706
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-3460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number97885
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: