Provider Demographics
NPI:1528005196
Name:BOLLEGRAF, MORRIS S (DO)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:S
Last Name:BOLLEGRAF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4000
Mailing Address - Fax:941-945-4963
Practice Address - Street 1:4805 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1706
Practice Address - Country:US
Practice Address - Phone:941-753-7843
Practice Address - Fax:941-753-7845
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001974207Q00000X
FLOS11876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000215753OtherBCBS
IN200279100AMedicaid
IN000000215753OtherBCBS
INH15855Medicare UPIN
IN08181850Medicare PIN