Individual
DR. KARL D BODENDORFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1615 SW MAIN BLVD, LAKE CITY, FL 32025-1108
(386) 755-2785
(386) 755-1128
Mailing address
PO BOX 489, LAKE CITY, FL 32056-0489
(386) 755-2785
(386) 755-2785
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME78478
FL
207W00000X
Ophthalmology Physician
Primary
ME78478
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001933700
—
FL
05
—
259120100
—
FL
05
—
259120101
—
FL
01
—
35612A
BC/BS
FL
01
—
P00087109
RAILROAD MEDICARE
FL
Enumeration date
08/31/2006
Last updated
04/02/2025
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