Healthcare Provider Details

I. General information

NPI: 1851355846
Provider Name (Legal Business Name): GARY E KOLB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 HAND AVE SUITE 2
BAY MINETTE AL
36507-4191
US

IV. Provider business mailing address

2305 HAND AVE SUITE 2
BAY MINETTE AL
36507-4198
US

V. Phone/Fax

Practice location:
  • Phone: 251-937-5652
  • Fax: 251-937-5954
Mailing address:
  • Phone: 251-937-5652
  • Fax: 251-937-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO35
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: