Individual
KEITH CHARLES BODLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12501 SILVER FOX LN, APARTMENT NUMBER 1, ANCHORAGE, AK 99515-3527
(907) 868-8661
Mailing address
PO BOX 233322, ANCHORAGE, AK 99523-3322
(907) 868-8661
(907) 868-8661
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
730834
STATE LICENSE
AK
01
—
CM31561
INDIVIDUAL IDENTIFICATION
AK
01
—
CMG616
AGENCY NUMBER
AK
Enumeration date
05/07/2007
Last updated
07/08/2007
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