Provider Demographics
NPI:1861573149
Name:FARKAS, GLEN C (MD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:C
Last Name:FARKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7230 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-518-5980
Mailing Address - Fax:818-337-2049
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 302
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:818-518-5980
Practice Address - Fax:818-337-2049
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2015-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG56249207W00000X, 208D00000X, 207QB0002X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACO4312Medicare UPIN