Individual
DR. JOHN BODKIN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-4170
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
DO3973
ME
207Q00000X
Family Medicine Physician
1975
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001416470
WV BCBS
WV
01
—
001716470
WV BCBS
WV
01
—
1063701
WV DWC
WV
05
—
1810622000
—
WV
Enumeration date
01/03/2006
Last updated
12/19/2024
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