Provider Demographics
NPI:1992123335
Name:BOHLIG, BRENTON CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:BRENTON
Middle Name:CHARLES
Last Name:BOHLIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 BETHESDA DRIVE
Mailing Address - Street 2:BUILDING 5, UNIT 1
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-586-6828
Mailing Address - Fax:740-586-6511
Practice Address - Street 1:950 BETHESDA DRIVE
Practice Address - Street 2:BUILDING 5, UNIT 1
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:740-586-6828
Practice Address - Fax:740-586-6511
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1371412081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine