Provider Demographics
NPI:1598897860
Name:BAREFOOT, ROBERT A JR
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:BAREFOOT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:ALLEN
Other - Last Name:BAREFOOT
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3655 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-2827
Mailing Address - Country:US
Mailing Address - Phone:843-716-7000
Mailing Address - Fax:
Practice Address - Street 1:3655 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2827
Practice Address - Country:US
Practice Address - Phone:843-716-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCT6123207PE0004X
NC34245207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7906327Medicaid
NC10209OtherBCBSNC
NCP00452442OtherRAILROAD MEDICARE
NC2183400PMedicare PIN
NCP00452442OtherRAILROAD MEDICARE
SCF52904Medicare UPIN
NC7906327Medicaid