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General NPI Number Information
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NPI Number | 1366763252
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Entity Type | Organization
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Legal Business Name | BRUCE A. BOLLINGER, MD PA
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 800 12TH AVE SUITE 300
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City | FORT WORTH
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State | TX
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Zip | 76104-2518
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Country | US
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Telephone | 817-877-1118
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Fax | 817-877-5317
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Provider Business Mailing Address
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Address Line | 800 12TH AVE SUITE 300
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City | FORT WORTH
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State | TX
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Zip | 76104-2518
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Country | US
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Telephone | 817-877-1118
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Fax | 817-877-5317
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | BRUCE ALAN BOLLINGER
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Credential | MD
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Telephone | 817-877-1118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H1468
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License Number State | TX
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