Healthcare Provider Details

I. General information

NPI: 1699743260
Provider Name (Legal Business Name): ROBERT L BURNAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MAIN ST SUITE 202
HILTON HEAD SC
29926-1648
US

IV. Provider business mailing address

23 MAIN ST SUITE 202
HILTON HEAD SC
29926-1648
US

V. Phone/Fax

Practice location:
  • Phone: 843-682-3583
  • Fax: 843-682-3597
Mailing address:
  • Phone: 843-682-3583
  • Fax: 843-682-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number26860
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number26860
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: