Provider Demographics
NPI:1477523454
Name:BOKOR, ANDREW B (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:BOKOR
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 1:6100 E MAIN ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3399
Mailing Address - Country:US
Mailing Address - Phone:614-759-6200
Mailing Address - Fax:614-759-6443
Practice Address - Street 1:6100 E MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3399
Practice Address - Country:US
Practice Address - Phone:614-759-6200
Practice Address - Fax:614-759-6443
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0240975Medicaid
OH9284101Medicare ID - Type Unspecified
OH0240975Medicaid