Healthcare Provider Details

I. General information

NPI: 1447282108
Provider Name (Legal Business Name): ROBERT WILLIAM NOLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 EASTERN BYP SUITE 5
RICHMOND KY
40475-2415
US

IV. Provider business mailing address

789 EASTERN BYP SUITE 5
RICHMOND KY
40475-2415
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-4110
  • Fax: 859-624-1968
Mailing address:
  • Phone: 859-624-4110
  • Fax: 859-624-1968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberCT31547
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR50195
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number48916
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: