MEDICARE: TIM G BOHN, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1689604498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIM G BOHN, MD

Provider Business Mailing Address
First Line	:	PO BOX 269047
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-9047
Country	:	US
Telephone Number	:	405-632-6025
Fax Number	:	405-632-4506

Provider Business Practice Location Address
First Line	:	8241 S WALKER AVE
Second Line	:	SUITE 100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9401
Country	:	US
Telephone Number	:	405-632-6025
Fax Number	:	405-632-4506

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIM GERARD BOHN
Credential	:	MD
Telephone Number	:	405-632-6025

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	02/10/2010

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