Provider Demographics
NPI:1477579795
Name:BOHL, DANIEL LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEROY
Last Name:BOHL
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 1:76 CAMPANELLI INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1809
Mailing Address - Country:US
Mailing Address - Phone:508-930-3062
Mailing Address - Fax:508-587-0287
Practice Address - Street 1:76 CAMPANELLI INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1809
Practice Address - Country:US
Practice Address - Phone:508-930-3062
Practice Address - Fax:508-587-0287
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200202484207RN0300X
MA235028207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
202912OtherMO-BLUE SHIELD
202912OtherMO-BLUE SHIELD