Basic Information
| Provider Information | |||||||||
| NPI: | 1972034452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOHMAN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 673 MDG / SGHQ | ||||||||
| Address2: | JB ELMENDORF-RICHARDSON USAF | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075802181 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5955 ZEAMER AVE | ||||||||
| Address2: | |||||||||
| City: | ELMENDORF AFB | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995063702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075802181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2017 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0800X | 31400 | NE | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208D00000X | 31400 | NE | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.