Provider Demographics
NPI:1245857036
Name:BOHNERT, SARAH MARIAH PETH (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MARIAH PETH
Last Name:BOHNERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:MARIAH
Other - Last Name:PETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 N HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2511
Mailing Address - Country:US
Mailing Address - Phone:573-642-5911
Mailing Address - Fax:573-642-3015
Practice Address - Street 1:110 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2511
Practice Address - Country:US
Practice Address - Phone:573-642-5911
Practice Address - Fax:573-642-3015
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020019023207Q00000X
MO2023009377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine