Provider Demographics
NPI:1700076841
Name:KOLBE, BRUCE A (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:KOLBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:FISKDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-0583
Mailing Address - Country:US
Mailing Address - Phone:508-347-9233
Mailing Address - Fax:
Practice Address - Street 1:40 MT DAN RD
Practice Address - Street 2:
Practice Address - City:FISKDALE
Practice Address - State:MA
Practice Address - Zip Code:01518-1042
Practice Address - Country:US
Practice Address - Phone:508-347-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75956207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology