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:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TOWNCENTER BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1832
Mailing Address - Country:US
Mailing Address - Phone:205-330-8820
Mailing Address - Fax:205-333-2515
Practice Address - Street 1:100 TOWNCENTER BLVD STE 111
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1832
Practice Address - Country:US
Practice Address - Phone:052-330-8820
Practice Address - Fax:205-333-2515
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24251208600000X, 2086S0122X
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