Individual
DR. FREDRICK JAMES BOHANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4801 MCHUGH RD STE C, ZACHARY, LA 70791-5364
(225) 570-2489
Mailing address
4801 MCHUGH RD STE C, ZACHARY, LA 70791-5364
(225) 570-2489
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
312263
LA
208600000X
Surgery Physician
BP1-0040982
TX
208600000X
Surgery Physician
Q1573
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14457559
CAQH
LA
05
—
2505696
—
LA
01
—
6B4259
FMC PTAN
LA
01
—
BP1-0040982
TEXAS MEDICAL BOARD, POSTGRADUATE TRAINING PERMIT
TX
Enumeration date
05/26/2011
Last updated
10/24/2023
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