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General NPI Number Information
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NPI Number | 1144344391
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Entity Type | Organization
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Legal Business Name | ROBERT W. BOHUS, M.D., F.A.C.S.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 S 11TH AVE STE 301
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City | POCATELLO
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State | ID
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Zip | 83201-4879
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Country | US
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Telephone | 208-233-3355
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Fax | 208-232-6118
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Provider Business Mailing Address
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Address Line | 500 S 11TH AVE STE 301
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City | POCATELLO
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State | ID
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Zip | 83201-4879
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Country | US
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Telephone | 208-233-3355
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Fax | 208-232-6118
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. ROBERT W. BOHUS
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Credential | M.D., F.A.C.S.
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Telephone | 208-233-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | M6361
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License Number State | ID
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