Healthcare Provider Details

I. General information

NPI: 1679530042
Provider Name (Legal Business Name): WILLIAM VICTOR BOBO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 CALLAWAY RD STE 101
TALLAHASSEE FL
32303-5268
US

IV. Provider business mailing address

2507 CALLAWAY RD
TALLAHASSEE FL
32303-5267
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-6543
  • Fax: 850-848-4400
Mailing address:
  • Phone: 850-644-5973
  • Fax: 850-848-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number55861
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41118
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101222168
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME125430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: