Provider Demographics
NPI:1669433298
Name:ALEXANDER, JOHN ROBERT JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:ALEXANDER
Suffix:JR
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 1:526 JOHNNIE DODDS BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3029
Mailing Address - Country:US
Mailing Address - Phone:843-856-9669
Mailing Address - Fax:843-856-9161
Practice Address - Street 1:526 JOHNNIE DODDS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-856-9669
Practice Address - Fax:843-856-9161
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC246632081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC246638Medicaid
SCAA07308133Medicare PIN
H96697Medicare UPIN