Healthcare Provider Details

I. General information

NPI: 1831162130
Provider Name (Legal Business Name): BOBBIE JO BEHRENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35670 KENAI SPUR HWY 101B
SOLDOTNA AK
99669-7626
US

IV. Provider business mailing address

35670 KENAI SPUR HWY 101B
SOLDOTNA AK
99669-7626
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-2615
  • Fax: 907-262-8842
Mailing address:
  • Phone: 907-262-2615
  • Fax: 907-262-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2471
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: