MEDICARE: HAL LESLIE BOZOF D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO0001658	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

General Provider Information

NPI Number	:	1346243748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAL LESLIE BOZOF D.P.M.

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	:	STE 2
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/22/2008

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