Provider Demographics
NPI:1871597781
Name:NOLAN, ROBERT BOND JR (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BOND
Last Name:NOLAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4119 BROWNS LN
Mailing Address - Street 2:STE 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1500
Mailing Address - Country:US
Mailing Address - Phone:502-451-9296
Mailing Address - Fax:502-451-9291
Practice Address - Street 1:4119 BROWNS LN
Practice Address - Street 2:STE 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1500
Practice Address - Country:US
Practice Address - Phone:502-451-9296
Practice Address - Fax:502-451-9291
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173000000X
KY23114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01-00257OtherUNITED HEALTHCARE
KY6319873OtherCIGNA
KY080195017OtherRAILROAD MEDICARE
KY000000246324OtherANTHEM
KY080195017OtherRAILROAD MEDICARE
KY01-00257OtherUNITED HEALTHCARE