Provider Demographics
NPI:1699782839
Name:DOLL, ROBERT D (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:DOLL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2477
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7619
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000600A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000640746OtherANTHEM PROVIDER NUMBER
IN000000343297OtherANTHEM PIN NUMBER
IN677730OOOMedicare PIN
IN677730Medicare PIN
IN970026738Medicare PIN
IN345000SMedicare PIN
IN000000640746OtherANTHEM PROVIDER NUMBER
IN815500BB3Medicare PIN
IN000000343297OtherANTHEM PIN NUMBER