Healthcare Provider Details

I. General information

NPI: 1669443891
Provider Name (Legal Business Name): ROBERT BRUCE NOLAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 N PROCTOR ST
TACOMA WA
98406-5227
US

IV. Provider business mailing address

209 LISCIO LOOP
GEORGETOWN TX
78628-4661
US

V. Phone/Fax

Practice location:
  • Phone: 253-905-5937
  • Fax:
Mailing address:
  • Phone: 253-905-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number409
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: