Provider Demographics
NPI:1134212012
Name:HAL BOZOF, DPM, PA
Entity type:Organization
Organization Name:HAL BOZOF, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOZOF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-278-4100
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1658213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340443900Medicaid
FL74835OtherBLUE CROSS BLUE SHIELD
FLK6024Medicare PIN
FL5894550001Medicare NSC