Basic Information
| Provider Information | |||||||||
| NPI: | 1598299935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOHM | ||||||||
| FirstName: | PARKER | ||||||||
| MiddleName: | EVAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2135 N COLLECTIVE LN | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162613220 | ||||||||
| FaxNumber: | 3162613298 | ||||||||
| Practice Location | |||||||||
| Address1: | 2135 N COLLECTIVE LN | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162613220 | ||||||||
| FaxNumber: | 3162613298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2017 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 04-46734 | KS | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 207WX0109X | 04-46734 | KS | Y |
No ID Information.