Provider Demographics
NPI:1053475541
Name:WILLIAM B HENGHOLD MD PA
Entity type:Organization
Organization Name:WILLIAM B HENGHOLD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BECKETT
Authorized Official - Last Name:HENGHOLD
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:850-474-4775
Mailing Address - Street 1:540 FONTAINE ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2019
Mailing Address - Country:US
Mailing Address - Phone:850-474-4775
Mailing Address - Fax:850-484-8223
Practice Address - Street 1:540 FONTAINE ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2019
Practice Address - Country:US
Practice Address - Phone:850-474-4775
Practice Address - Fax:850-484-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 92467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI28726Medicare UPIN
FLK7546Medicare PIN