Individual
MR. ROBERT LOUIS BODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
320 SKYVIEW DR, PARIS, KY 40361-1039
(859) 514-6675
(859) 514-5962
Mailing address
PO BOX 5327, PARIS, KY 40362-5327
(859) 514-6675
(859) 514-5962
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA044
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
755
NSAA
KY
01
—
SA044
KY BOARD OF MEDICAL LISCE
KY
Enumeration date
03/09/2007
Last updated
07/08/2007
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