Individual
GARY BOHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2024 S 6TH ST, BRAINERD, MN 56401-4529
(218) 825-7100
Mailing address
2024 S 6TH ST, BRAINERD, MN 56401-4529
(218) 825-7100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24755
MN
Other
Enumeration date
01/06/2006
Last updated
07/25/2007
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