Individual
DR. ROBERT MARK BODENHAMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4050 W MEMORIAL RD FL 3, OKLAHOMA CITY, OK 73120-8382
(405) 608-3800
(405) 608-4768
Mailing address
7800 NW 85TH TER, OKLAHOMA CITY, OK 73132-3385
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
12800
OK
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
12800
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020047750
RRMDR
OK
Enumeration date
09/01/2005
Last updated
06/06/2022
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