Provider Demographics
NPI:1104851419
Name:WOLOSKY, BRUCE DAVID (DPM)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:DAVID
Last Name:WOLOSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8534 SW HWY 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481
Mailing Address - Country:US
Mailing Address - Phone:352-237-2002
Mailing Address - Fax:352-861-3162
Practice Address - Street 1:8534 SW HWY 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481
Practice Address - Country:US
Practice Address - Phone:352-237-2002
Practice Address - Fax:352-861-3162
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02270213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U46942Medicare UPIN
65320YMedicare PIN