Provider Demographics
NPI:1063428001
Name:BOHANNON, NANCY J (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1580 VALENCIA ST
Mailing Address - Street 2:STE 504
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4415
Mailing Address - Country:US
Mailing Address - Phone:415-648-7622
Mailing Address - Fax:415-648-6805
Practice Address - Street 1:1580 VALENCIA ST
Practice Address - Street 2:STE 504
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4415
Practice Address - Country:US
Practice Address - Phone:415-648-7622
Practice Address - Fax:415-648-6805
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2017-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA25795207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25795OtherSTATE LICENSE
CAA25795OtherSTATE LICENSE
CAF03942Medicare UPIN