Provider Demographics
NPI:1467719567
Name:BRUCE D WOLOSKY DPM, PA
Entity Type:Organization
Organization Name:BRUCE D WOLOSKY DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WOLOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-237-2002
Mailing Address - Street 1:8534 SW HIGHWAY 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481
Mailing Address - Country:US
Mailing Address - Phone:352-237-2002
Mailing Address - Fax:352-861-3162
Practice Address - Street 1:8534 SW HIGHWAY 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-2100
Practice Address - Country:US
Practice Address - Phone:352-237-2002
Practice Address - Fax:352-861-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2270213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U46942Medicare UPIN
FZ482AMedicare PIN