Provider Demographics
NPI:1831166628
Name:JOHNSON, ROBERT DUREN JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DUREN
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2643 GREAT FALLS HWY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-7168
Mailing Address - Country:US
Mailing Address - Phone:803-286-1586
Mailing Address - Fax:803-313-3283
Practice Address - Street 1:672 HIGHWAY 9 W
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2130
Practice Address - Country:US
Practice Address - Phone:843-479-2402
Practice Address - Fax:843-479-6609
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8389207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC083894Medicaid
SC4469OtherMEDICARE GROUP NUMBER
NC30048OtherNC STATE LICENSE NUMBER
NC0120XOtherNC BCBS GROUP NUMBER
SC8389OtherSC MEDICAL LICENSE NUMBER
SCGP0789OtherSC MEDICAID GROUP NUMBER
SCGP0789OtherSC MEDICAID GROUP NUMBER
SC2966Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
SCAJ1957654OtherSC & FED. DEA NUMBER
SCC606042966Medicare ID - Type Unspecified