Healthcare Provider Details

I. General information

NPI: 1992875561
Provider Name (Legal Business Name): ROBERT PERKINS DILLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E GRAY STREET STE 802
LOUISVILLE KY
40202-3904
US

IV. Provider business mailing address

PO BOX 2469
LOUISVILLE KY
40201-2469
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-7670
  • Fax: 502-852-7743
Mailing address:
  • Phone: 502-852-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number14785
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: