Organization
KEITH C BODLEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH C BODLEY (OWNER)
(907) 868-8661
Entity
Organization
Contact information
Practice address
12501 SILVER FOX LN, APARTMENT #1, ANCHORAGE, AK 99515-3527
(907) 868-8661
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M00000X
—
AK
Enumeration date
07/24/2007
Last updated
07/28/2008
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