Provider Demographics
NPI:1184665929
Name:BOLLHOFER, WILLIAM J (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:BOLLHOFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9671
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9671
Mailing Address - Country:US
Mailing Address - Phone:386-445-7073
Mailing Address - Fax:386-445-7464
Practice Address - Street 1:309 PALM COAST PKWY NE
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3886
Practice Address - Country:US
Practice Address - Phone:386-445-7073
Practice Address - Fax:386-445-7464
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY213557207Q00000X
FLOS16591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01974203Medicaid
NY926071Medicare ID - Type Unspecified
NYG92549Medicare UPIN