Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 60108 | WI |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 60108-20 | WI |
NPI | 1114155041 |
---|---|
Provider Name | Dr. Justin Cody Bohrer |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 04/09/2020 |