Provider Demographics
NPI:1154373827
Name:PURVIS, ROBERT SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:PURVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3001 NEWCASTLE LOOP
Mailing Address - Street 2:ATTN: LISA BASS
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4502
Mailing Address - Country:US
Mailing Address - Phone:843-215-1100
Mailing Address - Fax:843-215-1211
Practice Address - Street 1:3001 NEWCASTLE LOOP
Practice Address - Street 2:ATTN: LISA BASS
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4502
Practice Address - Country:US
Practice Address - Phone:843-215-1100
Practice Address - Fax:843-215-1211
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17893207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890633FMedicaid
SC178952Medicaid
SCF40080Medicare UPIN
SC6314Medicare PIN