Basic Information
| Provider Information | |||||||||
| NPI: | 1679534887 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BOHAY | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5055 E BROADWAY BLVD | ||||||||
| Address2: | A-100 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857113640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203270460 | ||||||||
| FaxNumber: | 5207950225 | ||||||||
| Practice Location | |||||||||
| Address1: | 1951 N WILMOT RD | ||||||||
| Address2: | BUILDING 3 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857128000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203279573 | ||||||||
| FaxNumber: | 5203270391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 02/10/2012 | ||||||||
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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 | 207R00000X | 20864 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | Z180381 | 01 | AZ | PTAN | OTHER |