Individual
DR. CARL JAY BODENSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 W 8TH AVE, STE 336C, SPOKANE, WA 99204-2302
(509) 455-8855
(509) 455-8383
Mailing address
105 W 8TH AVE, STE 336C, SPOKANE, WA 99204-2302
(509) 455-8855
(509) 455-8383
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
MD00020651
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000108137
—
MT
05
—
000038801
—
ID
01
—
10004603
REGENCE BLUE S. OF IDAHO
WA
05
—
205997
—
OR
01
—
5404342
AETNA
WA
05
—
8458507
—
WA
01
—
911922781
PHCO
WA
05
—
911922781
—
WA
01
—
BO6528
ASURIS NW HEALTH
WA
01
—
KA345
BLUE CROSS OF IDAHO
WA
Enumeration date
02/08/2006
Last updated
12/21/2009
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