Healthcare Provider Details

I. General information

NPI: 1407524341
Provider Name (Legal Business Name): DON BOHANAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2021
Last Update Date: 09/04/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N PORTER AVE
NORMAN OK
73071-6421
US

IV. Provider business mailing address

5100 NW 155TH ST
EDMOND OK
73013-9687
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-1530
  • Fax:
Mailing address:
  • Phone: 405-205-1724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number3834
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: