Provider Demographics
NPI:1346243748
Name:BOZOF, HAL LESLIE (DPM)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:LESLIE
Last Name:BOZOF
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 1:2540 WINKLER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9338
Mailing Address - Country:US
Mailing Address - Phone:239-278-4100
Mailing Address - Fax:239-278-3907
Practice Address - Street 1:2540 WINKLER AVE
Practice Address - Street 2:STE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9338
Practice Address - Country:US
Practice Address - Phone:239-278-4100
Practice Address - Fax:239-278-3907
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001658213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340443900Medicaid
FL340443900Medicaid
5894550001Medicare NSC
FLT85799Medicare UPIN