Healthcare Provider Details

I. General information

NPI: 1861148140
Provider Name (Legal Business Name): AUSTIN M KOLBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JBSA-RANDOLPH CLINIC 221 THIRD ST WEST, BLDG 104
JBSA TX
78148
US

IV. Provider business mailing address

WILFORD HALL AMBULATORY SURGICAL CENTER 1100 WILFORD HALL LOOP, BLDG 4554, 59 MDW/GME
JBSA LACKLAND TX
78263-9908
US

V. Phone/Fax

Practice location:
  • Phone: 210-652-4264
  • Fax: 301-235-1678
Mailing address:
  • Phone: 210-916-9928
  • Fax: 210-916-9332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number36002
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: