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Individual
DR. MATTHEW S BODNER
Active
Individual
DR. MATTHEW S BODNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
10657
AL
207L00000X
Anesthesiology Physician
50121-20
WI
207L00000X
Anesthesiology Physician
R5J60
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202646105
—
MO
Enumeration date
07/17/2006
Last updated
09/20/2007
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