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General NPI Number Information
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NPI Number | 1366475568
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Entity Type | Individual
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Provider Name | HENRY CABOT LODGE BOHLER JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 9412 CIVIC WAY APT 210
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City | PROSPECT
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State | KY
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Zip | 40059-5103
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Country | US
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Telephone | 502-373-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 9412 CIVIC WAY APT 210
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City | PROSPECT
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State | KY
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Zip | 40059-5103
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Country | US
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Telephone | 502-444-5767
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 38316
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 38316
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207VB0002X
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Taxonomy Name | Obesity Medicine (Obstetrics & Gynecology) Physician
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License Number | 38316
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License Number State | KY
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