Provider Demographics
NPI:1598949232
Name:BOLLIG, REAGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:REAGAN
Middle Name:
Last Name:BOLLIG
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 1:1932 ALCOA HWY STE 270
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1537
Mailing Address - Country:US
Mailing Address - Phone:865-251-4658
Mailing Address - Fax:865-251-4659
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:BLDG. C STE 270
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1527
Practice Address - Country:US
Practice Address - Phone:865-251-4658
Practice Address - Fax:865-251-4659
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN493022086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141249Medicare UPIN