Healthcare Provider Details

I. General information

NPI: 1902807050
Provider Name (Legal Business Name): ROBERT D VOLLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 5TH ST N
COLUMBUS MS
39705-2008
US

IV. Provider business mailing address

PO BOX 1806
COLUMBUS MS
39703-1806
US

V. Phone/Fax

Practice location:
  • Phone: 662-327-6820
  • Fax: 662-327-9388
Mailing address:
  • Phone: 662-327-6820
  • Fax: 662-327-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number07755
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number07755
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: