Provider Demographics
NPI:1164543724
Name:WOLBRINK, ALEX MARK (MD, MS)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:MARK
Last Name:WOLBRINK
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3472 RESEARCH PKWY # 104-381
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1066
Mailing Address - Country:US
Mailing Address - Phone:682-233-2376
Mailing Address - Fax:888-590-6008
Practice Address - Street 1:3472 RESEARCH PKWY # 104-381
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1066
Practice Address - Country:US
Practice Address - Phone:682-233-2376
Practice Address - Fax:888-590-6008
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL90172083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine