Provider Demographics
NPI:1093711533
Name:CHOISSER, WILLIAM V (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:V
Last Name:CHOISSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1409 KINGSLEY AVE
Mailing Address - Street 2:STE 14A
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4541
Mailing Address - Country:US
Mailing Address - Phone:904-264-2297
Mailing Address - Fax:904-264-6266
Practice Address - Street 1:1409 KINGSLEY AVE
Practice Address - Street 2:STE 14A
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4541
Practice Address - Country:US
Practice Address - Phone:904-264-2297
Practice Address - Fax:904-264-6266
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0032641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD52055Medicare UPIN
FL10958ZMedicare ID - Type Unspecified