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General NPI Number Information
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NPI Number | 1427151778
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Entity Type | Individual
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Provider Name | TIMOTHY DEAN BOHLENDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 501 S. BURMA AVE.
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City | GILLETTE
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State | WY
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Zip | 82716-3246
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Country | US
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Telephone | 307-688-9255
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Fax | 307-688-7920
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Provider Business Mailing Address
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Address Line | PO BOX 3011
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City | GILLETTE
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State | WY
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Zip | 82717-3011
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Country | US
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Telephone | 307-688-2690
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Fax | 307-688-1486
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 8888A
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License Number State | WY
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