Individual
DR. ELISA K BODEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 9TH AVE, BUCK PAVILLION 3RD FLOOR, SEATTLE, WA 98101-2756
(206) 223-2319
Mailing address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-4373
(503) 418-4189
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
226232
MA
207RG0100X
Gastroenterology Physician
60 256098
NY
207RG0100X
Gastroenterology Physician
MD 60229173
WA
207RG0100X
Gastroenterology Physician
Primary
MD201931
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0284291
DEPT. OF LABOR AND INDUSTRIES
WA
01
—
1932167400
MONTANA DSHS
WA
05
—
1932167400
—
WA
Enumeration date
05/03/2006
Last updated
06/07/2021
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