Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | OMSPERMIT 24 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A64471 | CA |
NPI | 1013077239 |
---|---|
Provider Name | Dr. William B Bohannan |
First Address | Burlingame, CA 94010 |
Second Address | Burlingame, CA 94010-3228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |