Healthcare Provider Details

I. General information

NPI: 1013110659
Provider Name (Legal Business Name): ROBERT L THOMAS MD FCCP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RUBY ST
WALTERBORO SC
29488-2758
US

IV. Provider business mailing address

300 RUBY ST
WALTERBORO SC
29488-2758
US

V. Phone/Fax

Practice location:
  • Phone: 843-549-5599
  • Fax: 843-549-5512
Mailing address:
  • Phone: 843-549-5599
  • Fax: 843-549-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number17150
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number17150
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number17150
License Number StateSC

VIII. Authorized Official

Name: DR. ROBERT LAL THOMAS
Title or Position: OWNER
Credential: MD
Phone: 843-549-5599