Provider Demographics
NPI:1871586495
Name:NOLLNER, ROBERT MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:NOLLNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT # 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-752-2300
Mailing Address - Fax:901-737-7216
Practice Address - Street 1:8115 COUNTRY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2030
Practice Address - Country:US
Practice Address - Phone:901-752-2300
Practice Address - Fax:901-737-7216
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01176274OtherRAILROAD MEDICARE
TN4344825OtherBCBS
TN3068780Medicaid
TN3068780Medicaid
A96616Medicare UPIN
TN103I088492Medicare PIN