Individual
DR. FREDERIC JEROME KOLB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 W ARBOR DR # MC8890, SAN DIEGO, CA 92103-1911
(619) 543-6084
Mailing address
PO BOX 232410, SAN DIEGO, CA 92193-2410
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
SFP39
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23-7064656
UCSD MEDICAL GROUP
CA
01
—
95-6006144
UCSD PLASTIC SURGERY
CA
01
—
ZZZP3716Z
MEDI-CAL
CA
Enumeration date
05/14/2019
Last updated
10/03/2019
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