Provider Demographics
NPI:1740767219
Name:LONGSTAFFE, ROBERT (MD, FRCSC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:LONGSTAFFE
Suffix:
Gender:M
Credentials:MD, FRCSC
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:LONGSTAFFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FRCSC
Mailing Address - Street 1:108 CHANDLER CREST COURT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR STE C100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6322
Practice Address - Country:US
Practice Address - Phone:864-680-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD61279LL207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty