Provider Demographics
NPI:1376536508
Name:HENGHOLD, WILLIAM B II (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:HENGHOLD
Suffix:II
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:530 FONTAINE ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2019
Practice Address - Country:US
Practice Address - Phone:850-474-4775
Practice Address - Fax:850-484-8223
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92467207N00000X, 207N00000X
FLME 92467207ND0101X
ALMD.32973207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00221467OtherMEDICARE RAILROAD
AL592-27562OtherBCBS OF ALABAMA
FL16117OtherBCBS OF FLORIDA
AL59176824OtherBCBS OF ALABAMA
FL16117OtherBCBS OF FLORIDA
FLI28726Medicare UPIN