Healthcare Provider Details

I. General information

NPI: 1386024495
Provider Name (Legal Business Name): TIMOTHY BOHL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 W PALMETTO PARK RD STE 20
BOCA RATON FL
33433-3462
US

IV. Provider business mailing address

7050 W PALMETTO PARK RD STE 20
BOCA RATON FL
33433-3462
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-1623
  • Fax: 561-571-6319
Mailing address:
  • Phone: 561-367-1623
  • Fax: 561-571-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: