Provider Demographics
NPI:1760402291
Name:BOHR, ROBERT JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:BOHR
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 1:1400 S HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7577
Mailing Address - Country:US
Mailing Address - Phone:714-879-3400
Mailing Address - Fax:714-441-1998
Practice Address - Street 1:1400 S HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7577
Practice Address - Country:US
Practice Address - Phone:714-879-3400
Practice Address - Fax:714-441-1998
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34562207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G345620OtherMEDI-CAL
CAWG34562BMedicare ID - Type Unspecified
CAA45978Medicare UPIN
CAW1087AMedicare ID - Type Unspecified