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Individual
JACK BOODEN JR.
Active
Individual
JACK BOODEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.P.O.
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO 00503
—
224P00000X
Prosthetist
Primary
CPO 00503
—
Other
Enumeration date
03/28/2007
Last updated
09/11/2025
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