MEDICARE: ROBERT B. NOLAN, JR., MD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA353	KY

General Provider Information

NPI Number	:	1023153350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT B. NOLAN, JR., MD, PLLC

Provider Business Mailing Address
First Line	:	4119 BROWNS LN
Second Line	:	STE. 1
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1500
Country	:	US
Telephone Number	:	502-451-9296
Fax Number	:	502-451-9291

Provider Business Practice Location Address
First Line	:	4119 BROWNS LN
Second Line	:	STE. 1
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1500
Country	:	US
Telephone Number	:	502-451-9296
Fax Number	:	502-451-9291

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT BOND NOLAN JR.
Credential	:	MD
Telephone Number	:	502-451-9296

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	12/09/2009

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