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Individual

WILLIAM HORST GAZZOLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
1555 KINGSLEY AVE STE 503, ORANGE PARK, FL 32073-9207
(904) 278-5088
Mailing address
1555 KINGSLEY AVE STE 503, ORANGE PARK, FL 32073-9207
(904) 278-5088

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
LL39357
SC
208600000X
Surgery Physician
Primary
OS19211
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
SC
Enumeration date
06/09/2016
Last updated
10/12/2022
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