# DR. WILLIAM TODD BOHANNON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1023077864
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | J8466 | TX | Yes |

## Other

- **Enumeration date:** 03/21/2006
- **Last updated:** 12/03/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1454878-05 | — | TX |
| 01 | — | 8R3601 | BLUE SHIELD | TX |
| 01 | — | P00184720 | RR/MEDICARE | TX |