Healthcare Provider Details

I. General information

NPI: 1477523454
Provider Name (Legal Business Name): ANDREW B BOKOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 E MAIN ST SUITE 112
COLUMBUS OH
43213-3399
US

IV. Provider business mailing address

6100 E MAIN ST SUITE 112
COLUMBUS OH
43213-3399
US

V. Phone/Fax

Practice location:
  • Phone: 614-759-6200
  • Fax: 614-759-6443
Mailing address:
  • Phone: 614-759-6200
  • Fax: 614-759-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35068007
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: