Provider Demographics
NPI:1831162130
Name:BEHRENS, BOBBIE JO (MD)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JO
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35670 KENAI SPUR HWY
Mailing Address - Street 2:101B
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7626
Mailing Address - Country:US
Mailing Address - Phone:907-262-2615
Mailing Address - Fax:907-262-8842
Practice Address - Street 1:35670 KENAI SPUR HWY
Practice Address - Street 2:101B
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7626
Practice Address - Country:US
Practice Address - Phone:907-262-2615
Practice Address - Fax:907-262-8842
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2471Medicaid
AKMD2471Medicaid
AKK0000BKNBLMedicare PIN