Provider Demographics
NPI:1902895360
Name:BOHRER, MINDY S (MD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:S
Last Name:BOHRER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2623 S SEACREST BLVD
Practice Address - Street 2:SUTE 216
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7501
Practice Address - Country:US
Practice Address - Phone:561-742-0065
Practice Address - Fax:561-742-0105
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA76084207RH0003X
FLME96414207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200992Medicaid
FL56361OtherBCBS
FLP01594394OtherRR MEDICARE
FLP971234OtherOPTIMUM
FLQMP000003724595OtherMOLINA
FLP1035508OtherFREEDOM
FL14391OtherDIMENSION HEALTH
FL0841632OtherCIGNA
FL304945OtherAVMED
FL5760711OtherAETNA
FL0841632OtherCIGNA
FL14391OtherDIMENSION HEALTH
FL5760711OtherAETNA