Provider Demographics
NPI:1427151778
Name:BOHLENDER, TIMOTHY DEAN (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DEAN
Last Name:BOHLENDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3011
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3011
Mailing Address - Country:US
Mailing Address - Phone:307-688-2690
Mailing Address - Fax:307-688-1486
Practice Address - Street 1:501 S. BURMA AVE.
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3246
Practice Address - Country:US
Practice Address - Phone:307-688-9255
Practice Address - Fax:307-688-7920
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8888A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01277557Medicaid
D25000Medicare UPIN
CO01277557Medicaid