NPI 1003154725

Quinton Ty Bohannon, PAC

Practitioner Medical Physician Assistant Coalgate, OK

Practice location

Address: 108 W Ohio Ave, Coalgate, OK 74538-2827
Phone: (580) 927-2334

Registered specialties

Medical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X Licence 2239 (OK)

Other Physician Assistant providers in Oklahoma →

Registry record

NPI: 1003154725
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Jan 2013
Record last updated: 30 Jan 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.