Provider Demographics
NPI:1992771604
Name:BOHM, JOHN E (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:BOHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5267 WARNER AVE # 341
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4079
Mailing Address - Country:US
Mailing Address - Phone:310-993-6912
Mailing Address - Fax:
Practice Address - Street 1:120 W COLE BLVD STE B
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-9700
Practice Address - Country:US
Practice Address - Phone:760-890-0190
Practice Address - Fax:760-890-0160
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA051741207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF64406Medicare UPIN