Provider Demographics
NPI:1386884559
Name:BOZUNG, DORI C (AP)
Entity type:Individual
Prefix:MS
First Name:DORI
Middle Name:C
Last Name:BOZUNG
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SHENANDOAH ST.
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084
Mailing Address - Country:US
Mailing Address - Phone:904-687-5352
Mailing Address - Fax:
Practice Address - Street 1:88 RIBERIA ST.
Practice Address - Street 2:SUITE 110
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32085
Practice Address - Country:US
Practice Address - Phone:904-687-5352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2251171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist