Organization
E. JAMES BODMER, D.P.M., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD JAMES BODMER D.P.M. (PRESIDENT)
(480) 363-3066
Entity
Organization
Contact information
Practice address
9765 E DEAD SURE PL, GOLD CANYON, AZ 85218-7176
(480) 363-3066
Mailing address
9765 E DEAD SURE PL, GOLD CANYON, AZ 85218-7176
(480) 363-3066
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
0152
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0152
AZ LICENSE
AZ
Enumeration date
08/23/2007
Last updated
08/23/2007
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