Basic Information
| Provider Information | |||||||||
| NPI: | 1326059403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOHMAN | ||||||||
| FirstName: | BRADFORD | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2829 E 6200 S | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014763084 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5475 S 500 E | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844056905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008803566 | ||||||||
| FaxNumber: | 8017335872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 85-174080-1205 | UT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 870458780B01 | 01 | UT | EDUCATORS MUTUAL | OTHER | 52175 | 01 | UT | HEALTHY U | OTHER | 68295 | 01 | UT | PEHP | OTHER | 2000026 | 01 | UT | UNITED HEALTHCARE | OTHER | PR00182 | 01 | UT | MOLINA | OTHER | 107005086102 | 01 | UT | IHC | OTHER | 219494 | 01 | UT | ALTIUS | OTHER | 5823 | 01 | UT | DESERET MUTUAL | OTHER |