Quinton Ty Bohannon P.A.-C

NPI 1003154725 - Physician Assistant - 363AM0700X

NPI Details
NPI 1003154725
Gender Male
Enumeration Date 01/30/2013
Last Updated 01/30/2013
Entity Type Individual
Active Over 3 years ago
Practice Location
108 W OHIO AVE
COALGATE OK, 74538-2827, US
Phone (580) 927-2334
Fax
Business Location
108 W OHIO AVE
COALGATE OK, 74538-2827, US
Phone (580) 927-2334
Fax
Toxanomy
Taxonomy Code 363AM0700X
License State Oklahoma
License Number 2239
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According to our database, Quinton Ty Bohannon P.A.-C NPI is 1003154725, taxonomy code is 363AM0700X and license number is 2239, license state is located at Oklahoma. Quinton Ty Bohannon P.A.-C physically located at 108 W Ohio Ave, Coalgate OK, 74538-2827. NPI Number Quinton Ty Bohannon P.A.-C has the Individual type.

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1003154725 NPI number is provided on an as is basis without warranty of any kind. 1003154725 is maintained by the National Plan & Provider Enumeration System. The contents of Quinton Ty Bohannon P.A.-C are for informational purposes only.