Provider Demographics
NPI:1407814791
Name:PUGH, ROBERT L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:PUGH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4111 MURRELLS INLET RD
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6208
Mailing Address - Country:US
Mailing Address - Phone:843-651-0044
Mailing Address - Fax:843-357-0766
Practice Address - Street 1:4111 MURRELLS INLET RD
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6208
Practice Address - Country:US
Practice Address - Phone:843-651-0044
Practice Address - Fax:843-357-0766
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00982035OtherRAILROAD MEDICARE ID- RSFPN
SC184464Medicaid
SCG292766926Medicare PIN
SCP00982035OtherRAILROAD MEDICARE ID- RSFPN
SCG29276Medicare UPIN