Provider Demographics
NPI:1023110970
Name:BOHLANDER, MARK J (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:BOHLANDER
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 1:1531 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3310
Mailing Address - Country:US
Mailing Address - Phone:530-332-6856
Mailing Address - Fax:530-893-6861
Practice Address - Street 1:888 LAKESIDE VLG COMMONS
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-3979
Practice Address - Country:US
Practice Address - Phone:530-332-6856
Practice Address - Fax:530-893-6861
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56360207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG56360OtherLICENSE
CAG56360OtherLICENSE