Provider Demographics
NPI:1164451670
Name:GOLSON, ROBERT BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRUCE
Last Name:GOLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 LAMY LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3735
Mailing Address - Country:US
Mailing Address - Phone:318-387-3453
Mailing Address - Fax:318-323-9045
Practice Address - Street 1:1601 LAMY LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3735
Practice Address - Country:US
Practice Address - Phone:318-387-3453
Practice Address - Fax:318-323-9045
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0127142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1197971Medicaid
LA1197971OtherRAILROAD MEDICARE
LA1197971Medicaid
LA5L610CD03Medicare PIN