Healthcare Provider Details

I. General information

NPI: 1679552053
Provider Name (Legal Business Name): DANIEL JAMES BOHLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S MARKET ST SUITE 1
CORTEZ CO
81321-3502
US

IV. Provider business mailing address

1311 N MILDRED RD
CORTEZ CO
81321-2231
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-4291
  • Fax: 970-565-4419
Mailing address:
  • Phone: 970-564-2104
  • Fax: 970-564-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number50974
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number18988
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: