1437112919 NPI number — DR. BRUCE BOHMAN MD

Table of content: DR. BRUCE BOHMAN MD (NPI 1437112919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437112919 NPI number — DR. BRUCE BOHMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOHMAN
Provider First Name:
BRUCE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437112919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 HICKORY ST NW STE 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97321-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-812-5275
Provider Business Mailing Address Fax Number:
541-812-5276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 HICKORY ST NW STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97321-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-812-5275
Provider Business Practice Location Address Fax Number:
541-812-5276
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD11218 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD11218 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0189507 . This is a "WASHINGTON LABOR & INDUST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 268748 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8351769 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: C94267 . This is a "GROUP HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: C94267 . This is a "PROVIDENCE HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 059297000 . This is a "BC/BS OF OREGON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 010051611 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: JT4011 . This is a "PACC" identifier . This identifiers is of the category "OTHER".
  • Identifier: XPY185424 . This is a "MEDI CAL" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com