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General NPI Number Information
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NPI Number | 1710116520
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Entity Type | Individual
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Provider Name | ALBERT M. BOHOLST M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 730 S.E. 5TH TERRACE
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429
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Country | US
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Telephone | 352-795-0141
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Fax | 352-795-0141
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Provider Business Mailing Address
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Address Line | P.O. BOX 958
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City | CRYSTAL RIVER
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State | FL
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Zip | 34423
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Country | US
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Telephone | 352-795-0141
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Fax | 352-795-0141
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME36564
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License Number State | FL
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