Healthcare Provider Details

I. General information

NPI: 1659377380
Provider Name (Legal Business Name): JEFFREY LUKE BOHLING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFREY L BOHLING M.D.

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 GATEWAY BLVD STE 2300
NEWBURGH IN
47630-8966
US

IV. Provider business mailing address

4199 GATEWAY BLVD STE 2300
NEWBURGH IN
47630-8966
US

V. Phone/Fax

Practice location:
  • Phone: 812-858-4610
  • Fax: 812-858-4632
Mailing address:
  • Phone: 812-858-4610
  • Fax: 812-858-4632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01022969
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: