Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 27041 | AL |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | MD60147213 | WA |
NPI | 1497964720 |
---|---|
Provider Name | Isaac Arnold Bohannon |
First Address | Bellevue, WA 98004-8578 |
Second Address | Bellevue, WA 98004-8578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 18/05/2021 |