Healthcare Provider Details

I. General information

NPI: 1477509925
Provider Name (Legal Business Name): ROBERT P BOLLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TOWNCENTER BLVD STE 111
TUSCALOOSA AL
35406-1832
US

IV. Provider business mailing address

100 TOWNCENTER BLVD STE 111
TUSCALOOSA AL
35406-1832
US

V. Phone/Fax

Practice location:
  • Phone: 52-330-8820
  • Fax: 205-333-2515
Mailing address:
  • Phone: 205-330-8820
  • Fax: 205-333-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24251
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number24251
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: