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1265420301 NPI number — LYLE G BOHLMAN MD

NPI Number: 1265420301
Health Care Provider/Practitioner: LYLE G BOHLMAN MD

Information about “1265420301” NPI (LYLE G BOHLMAN MD) exists in 1265420301 in HTML format HTML  |  1265420301 in plain Text format TXT  |  1265420301 in PDF (Portable Document Format) PDF  |  1265420301 in an XML format XML  formats.

NPI Number : 1265420301 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265420301",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOHLMAN",
    "FirstName": "LYLE",
    "MiddleName": "G",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "195 CANAL ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MALDEN",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02148-6701",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "781-338-0500",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "610 AIRPORT RD SW STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HUNTSVILLE",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "35802-4304",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "256-429-4809",
    "PracticeLocationAddressFaxNumber": "256-429-4163",
    "EnumerationDate": "10/12/2005",
    "LastUpdateDate": "07/25/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "MD.37647",
        "LicenseNumberStateCode": "AL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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