MEDICARE: GARY E KOLB DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DO35	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51075536	OTHER	AL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851355846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY E KOLB DO

Provider Business Mailing Address
First Line	:	2305 HAND AVE
Second Line	:	SUITE 2
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4198
Country	:	US
Telephone Number	:	251-937-5652
Fax Number	:	251-937-5954

Provider Business Practice Location Address
First Line	:	2305 HAND AVE
Second Line	:	SUITE 2
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4191
Country	:	US
Telephone Number	:	251-937-5652
Fax Number	:	251-937-5954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	05/28/2009

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Directions to “ GARY E KOLB DO” Practice Location

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