Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 18135 | MN |
NPI | 1013992486 |
---|---|
Provider Name | James Andrew Bohrer |
First Address | Austin, MN 55912-2941 |
Second Address | Austin, MN 55912-2941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D48423 | (02) | MN |