Provider Demographics
NPI:1215909122
Name:WILLIAM V CHOISSER MD PA
Entity type:Organization
Organization Name:WILLIAM V CHOISSER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-264-2297
Mailing Address - Street 1:1677 WELLS RD STE A
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2383
Mailing Address - Country:US
Mailing Address - Phone:904-264-2297
Mailing Address - Fax:904-264-6266
Practice Address - Street 1:1677 WELLS RD STE A
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2383
Practice Address - Country:US
Practice Address - Phone:904-264-2297
Practice Address - Fax:904-264-6266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032641207Q00000X
FLME0053605207RG0300X
FLME0039226208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD61602Medicare UPIN
FL10958ZMedicare ID - Type UnspecifiedWILLIAM V. CHOISSER M.D.
FLD67134Medicare UPIN
FL15875YMedicare ID - Type UnspecifiedLILY S. ROCHA M.D.
FLD52055Medicare UPIN
FL12060WMedicare ID - Type UnspecifiedREGINA M. BIELAWSKI M.D.