Individual
DR. ROBERT LOUIS DE GROOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
119 W LOWMAN ST, MULLINS, SC 29574-3107
(843) 464-4000
(843) 464-4017
Mailing address
PO BOX 603898, CHARLOTTE, NC 28260-3898
(843) 464-4000
(843) 464-4017
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
17113
SC
208600000X
Surgery Physician
Primary
17113
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA89359493
MEDICARE
SC
05
—
GP 5462
—
SC
01
—
GP 9493
MEDICARE GROUP
SC
05
—
GP1384
—
SC
Enumeration date
05/04/2006
Last updated
10/08/2020
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