MEDICARE: DR. BRUCE BOHMAN 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	207P00000X	Emergency Medicine Physician	MD11218	OR
2	207Q00000X	Family Medicine Physician	MD11218	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	010051611	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0189507	OTHER		WASHINGTON LABOR & INDUST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	C94267	OTHER		GROUP HEALTH
5	C94267	OTHER		PROVIDENCE HEALTH PLANS
6	059297000	OTHER	OR	BC/BS OF OREGON
8	JT4011	OTHER		PACC
9	XPY185424	OTHER		MEDI CAL

General Provider Information

NPI Number	:	1437112919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE BOHMAN MD

Provider Business Mailing Address
First Line	:	400 HICKORY ST NW STE 303
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1700
Country	:	US
Telephone Number	:	541-812-5275
Fax Number	:	541-812-5276

Provider Business Practice Location Address
First Line	:	400 HICKORY ST NW STE 303
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1700
Country	:	US
Telephone Number	:	541-812-5275
Fax Number	:	541-812-5276

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	03/11/2013

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Directions to “ DR. BRUCE BOHMAN MD” Practice Location

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