MEDICARE: HAL BOZOF, DPM, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO1658	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	74835	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134212012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAL BOZOF, DPM, PA

Provider Business Mailing Address
First Line	:	2540 WINKLER AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9338
Country	:	US
Telephone Number	:	239-278-4100
Fax Number	:	239-278-3907

Provider Business Practice Location Address
First Line	:	2540 WINKLER AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9338
Country	:	US
Telephone Number	:	239-278-4100
Fax Number	:	239-278-3907

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HAL L BOZOF
Credential	:	DPM
Telephone Number	:	239-278-4100

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	10/17/2011

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