# DR. MATTHEW S BODNER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1164449674
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 10657 | AL | Yes |
| 207L00000X | Anesthesiology Physician | 50121-20 | WI | — |
| 207L00000X | Anesthesiology Physician | R5J60 | MO | — |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 09/20/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 202646105 | — | MO |