Provider Demographics
NPI:1689604498
Name:TIM G BOHN, MD
Entity Type:Organization
Organization Name:TIM G BOHN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:BOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-632-6025
Mailing Address - Street 1:PO BOX 269047
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9047
Mailing Address - Country:US
Mailing Address - Phone:405-632-6025
Mailing Address - Fax:405-632-4506
Practice Address - Street 1:8241 S WALKER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9401
Practice Address - Country:US
Practice Address - Phone:405-632-6025
Practice Address - Fax:405-632-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522410Medicare PIN