Healthcare Provider Details

I. General information

NPI: 1437353612
Provider Name (Legal Business Name): BROOKE COLIN BEAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4796 OLD TAR RD
WINTERVILLE NC
28590-9752
US

IV. Provider business mailing address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

V. Phone/Fax

Practice location:
  • Phone: 252-353-4111
  • Fax: 252-353-1727
Mailing address:
  • Phone: 252-413-6202
  • Fax: 252-758-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017-01519
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: