Individual
DR. WILLIAM TODD BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(800) 994-0371
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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