Individual
DR. BRUCE E. GOLLUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
775 POLE LINE RD W STE 103, TWIN FALLS, ID 83301-5819
(208) 814-8375
(208) 814-8376
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
80-158
NM
207Q00000X
Family Medicine Physician
Primary
M-17332
ID
208D00000X
General Practice Physician
80-158
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22491
—
NM
Enumeration date
10/18/2005
Last updated
11/30/2023
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