Individual
QUINTON TY BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
108 W OHIO AVE, COALGATE, OK 74538-2827
(580) 927-2334
Mailing address
108 W OHIO AVE, COALGATE, OK 74538-2827
(580) 927-2334
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2239
OK
Other
Enumeration date
01/30/2013
Last updated
01/30/2013
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