Individual
TIMOTHY P. BOHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.,M.D.,PA
Contact information
Practice address
6400 FANNIN STREET, SUITE 2740, HOUSTON, TX 77030-1539
(713) 621-4422
(713) 621-4055
Mailing address
6400 FANNIN STREET, SUITE 2740, HOUSTON, TX 77030-1539
(713) 621-4422
(713) 621-4055
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
H3784
TX
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
H3784
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009AT
BLUECROSS BLUE SHIELD TX
TX
05
—
136295612
—
TX
Enumeration date
05/19/2006
Last updated
03/19/2019
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