Active NPI
Theodore Weldon Bohlman, M.D.
- Gastroenterology Physician
- Meridian, ID
National Provider Identifier
1649516212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- M-5165
- Practice address
- 8820 Stewart Rd
Meridian, ID 83642-7226 - Phone
- (208) 841-0035
- NPI assigned
- Dec 29, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | M-5165 | ID | Primary |
Addresses
Primary practice location
8820 Stewart Rd
Meridian, ID 83642-7226
Mailing address
8820 Stewart Rd
Meridian, ID 83642-7226
Phone (208) 841-0035
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-5165 | ID | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1356739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356739200000",
"number": "1649516212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8820 STEWART RD",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836427226",
"telephone_number": "208-841-0035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8820 STEWART RD",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836427226",
"telephone_number": "208-841-0035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOHLMAN",
"first_name": "THEODORE",
"middle_name": "WELDON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-29",
"last_updated": "2012-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "ID",
"license": "M-5165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.