Individual
DR. ROBERT L. DETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
222 EAST MEDICAL LANE, SUITE 200, WEST COLUMBIA, SC 29169-4801
(803) 935-8410
(803) 936-7816
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
78809
MA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
11526
NH
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
78809
MA
208VP0014X
Interventional Pain Medicine Physician
Primary
81664
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110053869A
—
MA
05
—
30201961
—
NH
05
—
3118916
—
MA
01
—
80667
CIGNA
NH
01
—
M20928
MEDICARE GROUP
—
Enumeration date
09/06/2005
Last updated
10/27/2020
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