Individual
GAYLE B BODNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5779 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-04233
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
539124
—
AZ
Enumeration date
11/01/2006
Last updated
07/27/2016
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