Provider Demographics
NPI:1437112919
Name:BOHMAN, BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:BOHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HICKORY ST NW STE 303
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1700
Mailing Address - Country:US
Mailing Address - Phone:541-812-5275
Mailing Address - Fax:541-812-5276
Practice Address - Street 1:400 HICKORY ST NW STE 303
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1700
Practice Address - Country:US
Practice Address - Phone:541-812-5275
Practice Address - Fax:541-812-5276
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11218207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0189507OtherWASHINGTON LABOR & INDUST
OR268748Medicaid
WA8351769Medicaid
C94267OtherGROUP HEALTH
C94267OtherPROVIDENCE HEALTH PLANS
OR059297000OtherBC/BS OF OREGON
010051611OtherRAILROAD MEDICARE
JT4011OtherPACC
XPY185424OtherMEDI CAL
OR268748Medicaid
JT4011OtherPACC