| Name: | Robert P. Bolling, MD, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 03 Jun 2008 (16 years ago) (Companies founded in June 2008) |
| Entity Number: | 000-420-855 |
| Register Number: | 000420855 |
| ZIP code: | 36542 (Companies in Baldwin, 36542) |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 350 CYPRESS BEND DRGULF SHORES, AL 36542 |
| Principal Address: | GULF SHORES, AL |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164680914 | 2008-05-29 | 2013-07-25 | PO BOX 1005, FAYETTE, AL, 355551090, US | 1035 TEMPLE AVE N, FAYETTE, AL, 355551923, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-748-0158 |
| Fax | 2059324159 |
Authorized person
| Name | DR. ROBERT P. BOLLING |
| Role | OWNER |
| Phone | 2057480158 |
Taxonomy
| Taxonomy Code | 2086S0122X - Plastic and Reconstructive Surgery Physician |
| License Number | 24251 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 9185060 |
| State | AL |
| Issuer | MEDICAID-WINFIELD |
| Number | 143956 |
| State | AL |
| Issuer | MEDICAID-FAIRHOPE |
| Number | 144069 |
| State | AL |
| Issuer | BLUE CROSS |
| Number | 511-21951 |
| State | AL |
| Issuer | MEDICAID |
| Number | 135596 |
| State | AL |
| Name | Role |
|---|---|
| BOLLING, ROBERT P | Agent |
| Name | Role |
|---|---|
| BOLLING, ROBERT P | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
