Provider Demographics
NPI:1598299935
Name:BOHM, PARKER EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PARKER
Middle Name:EVAN
Last Name:BOHM
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 1:2135 N COLLECTIVE LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3560
Mailing Address - Country:US
Mailing Address - Phone:316-261-3220
Mailing Address - Fax:316-261-3298
Practice Address - Street 1:2135 N COLLECTIVE LN
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3560
Practice Address - Country:US
Practice Address - Phone:316-261-3220
Practice Address - Fax:316-261-3298
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-467342084N0400X, 207WX0109X
FLTRN247742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200097305Medicaid