Healthcare Provider Details

I. General information

NPI: 1871597781
Provider Name (Legal Business Name): ROBERT BOND NOLAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 BROWNS LN STE 1
LOUISVILLE KY
40220-1500
US

IV. Provider business mailing address

4119 BROWNS LN STE 1
LOUISVILLE KY
40220-1500
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-9296
  • Fax: 502-451-9291
Mailing address:
  • Phone: 502-451-9296
  • Fax: 502-451-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23114
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: