Basic Information
| Provider Information | |||||||||
| NPI: | 1558366039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EAGERTON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034355270 | ||||||||
| FaxNumber: | 8034330154 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E HOSPITAL ST | ||||||||
| Address2: | |||||||||
| City: | MANNING | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291023160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034330439 | ||||||||
| FaxNumber: | 8034339840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11415 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1558366039 | 01 | SC | RHC RIVERBEND | OTHER | 1821380197 | 01 | SC | GROUP NPI | OTHER | RHC065 | 05 | SC | MEDICAID | 010012018 | 01 | SC | RAILROAD MEDICARE | OTHER | 1558366039 | 01 | SC | RHC MEDICAID | OTHER |