Healthcare Provider Details

I. General information

NPI: 1164680914
Provider Name (Legal Business Name): ROBERT P. BOLLING, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TOWNCENTER BLVD STE 111
TUSCALOOSA AL
35406-1832
US

IV. Provider business mailing address

PO BOX 1005
FAYETTE AL
35555-1090
US

V. Phone/Fax

Practice location:
  • Phone: 205-330-8820
  • Fax: 205-333-2515
Mailing address:
  • Phone: 205-748-0158
  • Fax: 205-932-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number24251
License Number StateAL

VIII. Authorized Official

Name: ROBERT P BOLLING
Title or Position: OWNER
Credential: MD
Phone: 205-330-8820