Provider Demographics
NPI:1437117561
Name:HOLLABAUGH, ROBERT STERLING JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STERLING
Last Name:HOLLABAUGH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1325 WOLF PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1742
Mailing Address - Country:US
Mailing Address - Phone:901-252-3411
Mailing Address - Fax:901-384-6422
Practice Address - Street 1:125 GUTHRIE DR STE 102
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5829
Practice Address - Country:US
Practice Address - Phone:662-349-1964
Practice Address - Fax:901-763-4305
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS15804208800000X
TN30313208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
97879OtherBLUE CROSS AR
13137372OtherPHCS
133261OtherHEALTH LINK
4025294OtherAETNA
0210025600OtherQUAL CHOICE
TN3823224Medicaid
1201660OtherFIRST HEALTH
TN3095141OtherBLUE CROSS
4574106OtherCIGNA
TN3095141OtherBLUE CROSS
TN3095141OtherBLUE CROSS