Healthcare Provider Details

I. General information

NPI: 1164482683
Provider Name (Legal Business Name): ROBERT LAFITTE ELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DOCTORS DR
GREENVILLE SC
29605-4266
US

IV. Provider business mailing address

1 DOCTORS DR
GREENVILLE SC
29605-4266
US

V. Phone/Fax

Practice location:
  • Phone: 864-572-7001
  • Fax: 864-412-0645
Mailing address:
  • Phone: 864-572-7001
  • Fax: 864-412-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number39005
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number39005
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: