MEDICARE: DR. ROBERT SCOTT PURVIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	17893	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154373827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT SCOTT PURVIS MD

Provider Business Mailing Address
First Line	:	3001 NEWCASTLE LOOP
Second Line	:	ATTN: LISA BASS
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4502
Country	:	US
Telephone Number	:	843-215-1100
Fax Number	:	843-215-1211

Provider Business Practice Location Address
First Line	:	3001 NEWCASTLE LOOP
Second Line	:	ATTN: LISA BASS
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4502
Country	:	US
Telephone Number	:	843-215-1100
Fax Number	:	843-215-1211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	12/04/2012

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