Provider Demographics
NPI:1679530042
Name:BOBO, WILLIAM VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VICTOR
Last Name:BOBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2507 CALLAWAY RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5267
Mailing Address - Country:US
Mailing Address - Phone:850-644-5973
Mailing Address - Fax:850-848-4400
Practice Address - Street 1:2507 CALLAWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5268
Practice Address - Country:US
Practice Address - Phone:850-644-6543
Practice Address - Fax:850-848-4400
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN558612084P0800X
TN411182084P0800X
VA01012221682084P0800X
FLME1254302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260003774Medicare PIN