Healthcare Provider Details

I. General information

NPI: 1093951311
Provider Name (Legal Business Name): ROBERT BLAKE WINDSOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 N CHURCH ST STE 102
GREENVILLE SC
29601-1769
US

IV. Provider business mailing address

19 CONESTEE AVE PO BOX 8027
GREENVILLE SC
29604-1001
US

V. Phone/Fax

Practice location:
  • Phone: 864-214-6766
  • Fax:
Mailing address:
  • Phone: 864-214-6766
  • Fax: 864-448-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number262716
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52506
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number2021-00338
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: