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Organization
JOHN BODEN MD LLC
Active
Organization
JOHN BODEN MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN M BODEN M.D. (PRESIDENT/PHYSICIAN)
(850) 502-1363
Entity
Organization
Contact information
Practice address
6879 US HIGHWAY 98 W, SANTA ROSA BEACH, FL 32459-3257
(850) 502-1363
(850) 837-4837
Mailing address
42 INDIAN BAYOU DR, DESTIN, FL 32541-4447
(850) 502-1363
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME94719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009912339
—
AL
05
—
009912342
—
FL
05
—
044554100
—
FL
Enumeration date
08/15/2008
Last updated
12/22/2008
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