Individual
DR. EDWARD JAMES BODMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
9765 E DEAD SURE PL, GOLD CANYON, AZ 85218-7176
(480) 363-3066
(480) 983-8153
Mailing address
6499 S KINGS RANCH RD, STE 6, GOLD CANYON, AZ 85118-2920
(480) 982-8137
(480) 983-8153
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0152
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118594
MEDICARE GROUP
AZ
Enumeration date
09/22/2005
Last updated
04/19/2018
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