Provider Demographics
NPI:1851335038
Name:VON BARGEN, WILLIAM FREDERICK JR (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:VON BARGEN
Suffix:JR
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 1:1450 S WOODLAND BLVD
Mailing Address - Street 2:200-A
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-7767
Mailing Address - Country:US
Mailing Address - Phone:386-279-0943
Mailing Address - Fax:
Practice Address - Street 1:1450 S WOODLAND BLVD
Practice Address - Street 2:200-A
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7767
Practice Address - Country:US
Practice Address - Phone:386-279-0943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9286207Q00000X
FL9286204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004019300Medicaid
FL004019300Medicaid