Provider Demographics
NPI:1710928130
Name:BOHLEN, BARRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:BOHLEN
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 1:520 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-1225
Mailing Address - Country:US
Mailing Address - Phone:402-462-2139
Mailing Address - Fax:402-462-2381
Practice Address - Street 1:2207 OSBORNE DR W
Practice Address - Street 2:SUITE 100
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-9112
Practice Address - Country:US
Practice Address - Phone:402-462-2139
Practice Address - Fax:402-462-2381
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN70456207X00000X
NE21904207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE277092Medicare ID - Type Unspecified
NEH48884Medicare UPIN