Provider Demographics
NPI:1023637477
Name:BOHN, JOSH
Entity type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:BOHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PEMBERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43450-9694
Mailing Address - Country:US
Mailing Address - Phone:419-376-7297
Mailing Address - Fax:
Practice Address - Street 1:3225 PICKLE RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4026
Practice Address - Country:US
Practice Address - Phone:419-693-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT004377207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine