MEDICARE: DR. HAROLD RAY BOHMAN M.D.

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	208600000X	Surgery Physician	G33753	CA
2	208C00000X	Colon & Rectal Surgery Physician	G33753	CA

General Provider Information

NPI Number	:	1891793600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD RAY BOHMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 555191
Second Line	:	NAVAL HOSPITAL, DEPT OF SURGERY
City	:	CAMP PENDLETON
State	:	CA
Zip	:	92055-5191
Country	:	US
Telephone Number	:	760-725-1356
Fax Number	:	760-725-0117

Provider Business Practice Location Address
First Line	:	NAVAL HOSPITAL
Second Line	:	DEPT OF SURGERY
City	:	CAMP PENDLETON
State	:	CA
Zip	:	92055-5191
Country	:	US
Telephone Number	:	760-725-1356
Fax Number	:	760-725-0117

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	12/19/2011

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