Healthcare Provider Details

I. General information

NPI: 1285644567
Provider Name (Legal Business Name): ANTHONY BOHL APA-C, MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAMBERG CLINIC
APO AE
09139
DE

IV. Provider business mailing address

HHC 173RD STB UNIT 31421 BOX 476
APO AE
09139
DE

V. Phone/Fax

Practice location:
  • Phone: 4697772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: