Individual
BRANDON KARL BODLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4410 W NEWBERRY RD STE B, GAINESVILLE, FL 32607-2290
(353) 372-7800
(352) 372-7800
Mailing address
4410 W NEWBERRY RD STE B, GAINESVILLE, FL 32607-2290
(352) 372-7800
(352) 372-7879
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS9633
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302712
AVMED
FL
01
—
45751
BCBS
FL
01
—
4664818
CIGNA
FL
01
—
SG081521
VISTA HEALTHPLAN
FL
Enumeration date
07/05/2006
Last updated
07/09/2007
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