Provider Demographics
NPI:1457386518
Name:BOHN, TIM GERARD (MD)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:GERARD
Last Name:BOHN
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:PO BOX 269047
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9047
Mailing Address - Country:US
Mailing Address - Phone:405-632-6025
Mailing Address - Fax:405-632-4506
Practice Address - Street 1:8241 S WALKER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9401
Practice Address - Country:US
Practice Address - Phone:405-632-6025
Practice Address - Fax:405-632-4506
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK244502503Medicare PIN
OKD34420Medicare UPIN