Provider Demographics
NPI:1801830450
Name:COLLEY, BRUCE A (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:COLLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:605B GORDON DRIVE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2551
Mailing Address - Country:US
Mailing Address - Phone:610-363-0248
Mailing Address - Fax:610-363-4004
Practice Address - Street 1:142 WALLACE AVE STE 201
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335
Practice Address - Country:US
Practice Address - Phone:610-873-2700
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2020-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006366-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE23146Medicare UPIN