Individual
DR. MARC E BODDICKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5410 SHERIDAN LAKE RD, RAPID CITY, SD 57702-9208
(605) 390-0900
Mailing address
PO BOX 20528, FOUNTAIN HILLS, AZ 85269-0528
(605) 390-0900
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
1485
SD
207ND0101X
MOHS-Micrographic Surgery Physician
1485
SD
207ND0900X
Dermatopathology Physician
1485
SD
207NS0135X
Procedural Dermatology Physician
1485
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070013291
RR MEDICARE
SD
01
—
41192855200
NE MEDICAID
SD
05
—
5900162
—
SD
Enumeration date
02/16/2006
Last updated
03/11/2026
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