Provider Demographics
NPI:1063727576
Name:RILEY, ROBERT SHANE (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SHANE
Last Name:RILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-782-7800
Mailing Address - Fax:270-843-0779
Practice Address - Street 1:165 NATCHEZ TRACE AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7940
Practice Address - Country:US
Practice Address - Phone:270-782-7800
Practice Address - Fax:270-843-0779
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOTO13837207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery