Provider Demographics
NPI:1700870342
Name:BOGGS, WILLIAM MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MORRIS
Last Name:BOGGS
Suffix:
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 1:1714 SW WACAHOOTA RD
Mailing Address - Street 2:
Mailing Address - City:MICANOPY
Mailing Address - State:FL
Mailing Address - Zip Code:32667-5242
Mailing Address - Country:US
Mailing Address - Phone:352-682-2098
Mailing Address - Fax:
Practice Address - Street 1:1714 SW WACAHOOTA RD
Practice Address - Street 2:
Practice Address - City:MICANOPY
Practice Address - State:FL
Practice Address - Zip Code:32667-5242
Practice Address - Country:US
Practice Address - Phone:352-682-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 101893207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBX831ZMedicare UPIN