Provider Demographics
NPI:1164680914
Name:ROBERT P. BOLLING, MD, LLC
Entity Type:Organization
Organization Name:ROBERT P. BOLLING, MD, LLC
Other - Org Name:BOLLING PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-748-0158
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-1090
Mailing Address - Country:US
Mailing Address - Phone:205-748-0158
Mailing Address - Fax:205-932-4159
Practice Address - Street 1:1035 TEMPLE AVE N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1923
Practice Address - Country:US
Practice Address - Phone:205-748-0158
Practice Address - Fax:205-932-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL242512086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL9185060OtherAETNA
AL143956OtherMEDICAID-WINFIELD
AL144069OtherMEDICAID-FAIRHOPE
AL511-21951OtherBLUE CROSS
AL135596Medicaid
AL9185060OtherAETNA
AL135596Medicaid
AL510G700269Medicare PIN