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General NPI Number Information
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NPI Number | 1417990128
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Entity Type | Individual
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Provider Name | WILLIAM E BOLGER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 6817 SOUTHPOINT PKWY STE 502
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6289
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Country | US
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Telephone | 904-595-7475
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Fax |
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Provider Business Mailing Address
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Address Line | 6817 SOUTHPOINT PKWY STE 502
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6289
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Country | US
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Telephone | 904-595-7475
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | D60607
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME104254
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License Number State | FL
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