Provider Demographics
NPI:1528035698
Name:MAGRUDER, ROBERT LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:MAGRUDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28741-7600
Mailing Address - Country:US
Mailing Address - Phone:828-526-1284
Mailing Address - Fax:
Practice Address - Street 1:57 WHITE OWL LN
Practice Address - Street 2:
Practice Address - City:CASHIERS
Practice Address - State:NC
Practice Address - Zip Code:28717-4514
Practice Address - Country:US
Practice Address - Phone:828-743-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1307928-08Medicaid
TXD66871Medicare UPIN
TX1307928-08Medicaid