Healthcare Provider Details

I. General information

NPI: 1851335038
Provider Name (Legal Business Name): WILLIAM FREDERICK VON BARGEN JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CITRUS BLVD
LEESBURG FL
34748-3063
US

IV. Provider business mailing address

2500 CITRUS BLVD # 200-A
LEESBURG FL
34748-3063
US

V. Phone/Fax

Practice location:
  • Phone: 407-450-6991
  • Fax: 877-450-4723
Mailing address:
  • Phone: 850-765-6686
  • Fax: 877-450-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number9286
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9286
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: