Gollub, Bruce E.

Gollub, Bruce E. is an individual health care provider with primary practice located at 775 Pole Line Rd W Ste 103 , Twin Falls ID 83301-5819. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Gollub, Bruce E. can be contacted via phone (208) 814-8375.

Contact Information

Primary practice address
775 Pole Line Rd W Ste 103 Twin Falls ID 83301-5819
Phone: (208) 814-8375
Fax: (208) 814-8376
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 80-158 New Mexico
Allopathic & Osteopathic Physicians / General Practice 208D00000X 80-158 New Mexico
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M-17332 Idaho

Profile Details

NPI number 1508855917
LBN Legal business name Gollub, Bruce E.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 18th, 2005
Last updated Nov 30th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508855917 NPPES
New Mexico MEDICAID 22491

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