Provider Demographics
NPI:1790706406
Name:SABALA, BOZENA BARBARA (DO)
Entity Type:Individual
Prefix:DR
First Name:BOZENA
Middle Name:BARBARA
Last Name:SABALA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S. HERCULES AVE.
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764
Mailing Address - Country:US
Mailing Address - Phone:727-443-3832
Mailing Address - Fax:727-443-7903
Practice Address - Street 1:525 S. HERCULES AVE.
Practice Address - Street 2:UNIT 1
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764
Practice Address - Country:US
Practice Address - Phone:727-443-3832
Practice Address - Fax:727-443-7903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3539988OtherAETNA
FL44624OtherBCBS
FL3899253OtherCIGNA
FL44624ZMedicare ID - Type Unspecified
FL44624OtherBCBS