Provider Demographics
NPI:1184684433
Name:VOGENITZ, WILLIAM F (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:VOGENITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 504903
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4903
Mailing Address - Country:US
Mailing Address - Phone:864-716-2662
Mailing Address - Fax:864-716-2627
Practice Address - Street 1:1 SPRINGBACK WAY
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-716-2662
Practice Address - Fax:864-716-2627
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23454208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT77930Medicaid
SC250010775Medicare PIN
SCT77930Medicaid
SC8287Medicare PIN
SCG965928287Medicare PIN