Provider Demographics
NPI:1952308678
Name:BOHN, JEFFREY L (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:BOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:1424 EAST FRONT
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8501
Practice Address - Country:US
Practice Address - Phone:903-595-4144
Practice Address - Fax:903-596-7541
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1781207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5220532OtherAETNA
TX89V981OtherBLUE CROSS BLUE SHIELD
TX129098306Medicaid
TX129098304Medicaid
TX1477891OtherUNITED HEALTHCARE
TXP02098854OtherMEDICARE RAIL ROAD
TX704966OtherMEDICARE
TX2061748OtherCIGNA
TX609159OtherFIRST HEALTH