MEDICARE: DR. JAMES R BOHNSACK M.D.

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	2023022916	MO

General Provider Information

NPI Number	:	1821041914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R BOHNSACK M.D.

Provider Business Mailing Address
First Line	:	969 COMMERCE ST APT 1501
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5414
Country	:	US
Telephone Number	:	817-505-9707
Fax Number	:	817-263-9398

Provider Business Practice Location Address
First Line	:	969 COMMERCE ST APT 1501
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5414
Country	:	US
Telephone Number	:	817-505-9707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/07/2025

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