Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 244054 | NY |
Y | 207T00000X | Neurosurgeon | 7625702-1205 | UT |
N | 207T00000X | Neurosurgeon | P0701 | TX |
NPI | 1013129584 |
---|---|
Provider Name | Dr. Robert John Bollo |
First Address | Salt Lake City, UT 84141-3030 |
Second Address | Salt Lake City, UT 84132-0100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 28/10/2021 |