Healthcare Provider Details

I. General information

NPI: 1558366039
Provider Name (Legal Business Name): ROBERT S EAGERTON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E HOSPITAL ST
MANNING SC
29102-3160
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 803-433-0439
  • Fax: 803-433-9840
Mailing address:
  • Phone: 803-435-5270
  • Fax: 803-433-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11415
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: