Provider Demographics
NPI:1881946630
Name:BHOLA, DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BHOLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:303 N CLYDE MORRIS BLVD
Mailing Address - Street 2:HOSPITALIST SERVICES
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4522
Mailing Address - Country:US
Mailing Address - Phone:386-425-4542
Mailing Address - Fax:386-425-7705
Practice Address - Street 1:303 N CLYDE MORRIS BLVD
Practice Address - Street 2:HOSPITALIST SERVICES
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-425-4542
Practice Address - Fax:321-452-1185
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS14188207Q00000X, 208M00000X
TN2943207R00000X, 208M00000X
VA0102203661207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025158100Medicaid
VAVVL001B288Medicare PIN