Provider Demographics
NPI:1972673515
Name:BOLBOCK, BRUCE L (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:L
Last Name:BOLBOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 141456
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78714
Mailing Address - Country:US
Mailing Address - Phone:512-225-6350
Mailing Address - Fax:512-225-6344
Practice Address - Street 1:7900 FM 1826
Practice Address - Street 2:BUILDING ONE, DEPT OF ANESTHESIOLOGY
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737
Practice Address - Country:US
Practice Address - Phone:512-324-9008
Practice Address - Fax:512-324-9086
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24332207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F4040OtherBC
8F4040OtherBC
B21358Medicare UPIN