Provider Demographics
NPI:1558366039
Name:EAGERTON, ROBERT S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:EAGERTON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:803-435-5270
Mailing Address - Fax:803-433-0154
Practice Address - Street 1:200 E HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3160
Practice Address - Country:US
Practice Address - Phone:803-433-0439
Practice Address - Fax:803-433-9840
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC11415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1558366039OtherRHC RIVERBEND
SC1821380197OtherGROUP NPI
SCRHC065Medicaid
SC010012018OtherRAILROAD MEDICARE
SC1558366039OtherRHC MEDICAID
SCB919530281Medicare PIN
SCRHC065Medicaid
SC423864Medicare Oscar/Certification