Provider Demographics
NPI:1477509925
Name:BOLLING, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:BOLLING
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL242512086S0122X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL262671365001OtherTRICARE-FAIRHOPE
AL511-21951OtherBLUE CROSS
AL144069OtherMEDICAID-FAIRHOPE
AL135596Medicaid
AL143956OtherMEDICAID- WINFIELD
AL9185060OtherAETNA
AL721361759OtherGREATWEST
AL144069OtherMEDICAID-FAIRHOPE
AL9185060OtherAETNA
AL511-21951OtherBLUE CROSS
AL510G700269Medicare UPIN