MEDICARE: BRADLEY JOSEPH BOHNERT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	26545	AZ
2	2085N0700X	Neuroradiology Physician	26545	AZ
3	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	26545	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZWCBBM	OTHER	AZ	GROUP MEDICARE ID
3	CS7943	OTHER	AZ	GROUP MEDICARE RAILROAD ID & PTAN
7	300111649	OTHER	AZ	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1073583365	OTHER	AZ	PHYSICIAN INDIVIDUAL NPI
6	1841261989	OTHER	AZ	GROUP NPI

General Provider Information

NPI Number	:	1073583365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY JOSEPH BOHNERT MD

Provider Business Mailing Address
First Line	:	677 N WILMOT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2701
Country	:	US
Telephone Number	:	520-795-2889
Fax Number	:	520-795-6321

Provider Business Practice Location Address
First Line	:	677 N WILMOT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2701
Country	:	US
Telephone Number	:	520-795-2889
Fax Number	:	520-795-6321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	02/27/2013

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Directions to “ BRADLEY JOSEPH BOHNERT MD” Practice Location

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