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General NPI Number Information
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NPI Number | 1558366039
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Entity Type | Individual
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Provider Name | ROBERT S EAGERTON JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 200 E HOSPITAL ST
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City | MANNING
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State | SC
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Zip | 29102-3160
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Country | US
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Telephone | 803-433-0439
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Fax | 803-433-9840
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Provider Business Mailing Address
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Address Line | PO BOX 3239
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City | FLORENCE
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State | SC
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Zip | 29502-3239
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Country | US
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Telephone | 803-435-5270
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Fax | 803-433-0154
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11415
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License Number State | SC
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