MEDICARE: MR. ROBERT BOND NOLAN JR. MD

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	173000000X	Legal Medicine		KY
2	207Q00000X	Family Medicine Physician	23114	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080195017	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01-00257	OTHER	KY	UNITED HEALTHCARE
2	6319873	OTHER	KY	CIGNA
4	000000246324	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1871597781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT BOND NOLAN JR. MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	12/09/2009

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1023153350 — ROBERT B. NOLAN, JR., MD, PLLC
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Directions to “ MR. ROBERT BOND NOLAN JR. MD” Practice Location

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