Provider Demographics
NPI:1962636613
Name:BOHBOT, JASON A
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:BOHBOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 NE CAMANO DR
Mailing Address - Street 2:SUITE 5 # 283
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-7279
Mailing Address - Country:US
Mailing Address - Phone:206-877-2937
Mailing Address - Fax:
Practice Address - Street 1:4300 198TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6771
Practice Address - Country:US
Practice Address - Phone:425-778-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00015302174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist