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NPI Code Detail

MEDICARE: TIMOTHY P. BOHAN PH.D.,M.D.,PA

MEDICARE:   TIMOTHY P. BOHAN  PH.D.,M.D.,PA
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
12080P0008XPediatric Neurodevelopmental Disabilities PhysicianH3784TX
22080P0006XDevelopmental - Behavioral Pediatrics PhysicianH3784TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10009ATOTHERTXBLUECROSS BLUE SHIELD TX
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669426490
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY P. BOHAN PH.D.,M.D.,PA
Provider Business Mailing Address
First Line : 6400 FANNIN STREET
Second Line : SUITE 2740
City : HOUSTON
State : TX
Zip : 77030-1539
Country : US
Telephone Number : 713-621-4422
Fax Number : 713-621-4055
Provider Business Practice Location Address
First Line : 6400 FANNIN STREET
Second Line : SUITE 2740
City : HOUSTON
State : TX
Zip : 77030-1539
Country : US
Telephone Number : 713-621-4422
Fax Number : 713-621-4055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 03/19/2019

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