Individual
TODD BOHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
503 GEORGE MCCLAIN DR, BENTON, KY 42025-1331
(270) 527-8144
Mailing address
1703 JOHNSON BLVD, MURRAY, KY 42071-2264
(270) 761-1999
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
33599
KY
207Q00000X
Family Medicine Physician
33599
KY
207QS0010X
Sports Medicine (Family Medicine) Physician
33599
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000056871
BCBS
KY
05
—
64005317
—
KY
Enumeration date
09/26/2006
Last updated
01/18/2008
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