Individual
DR. WILLIAM TODD BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
J8466
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454878-05
—
TX
01
—
8R3601
BLUE SHIELD
TX
01
—
P00184720
RR/MEDICARE
TX
Enumeration date
03/21/2006
Last updated
12/03/2021
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