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NPI Code Detail

MEDICARE: DR. MARC E BODDICKER MD

MEDICARE: DR. MARC E BODDICKER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ND0101XMOHS-Micrographic Surgery Physician1485SD
2207N00000XDermatology Physician1485SD
3207ND0900XDermatopathology Physician1485SD
4207NS0135XProcedural Dermatology Physician1485SD

General Provider Information

NPI Number : 1235103060
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARC E BODDICKER MD
Provider Business Mailing Address
First Line : PO BOX 20528
Second Line :
City : FOUNTAIN HILLS
State : AZ
Zip : 85269-0528
Country : US
Telephone Number : 605-390-0900
Fax Number :
Provider Business Practice Location Address
First Line : 5410 SHERIDAN LAKE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-9208
Country : US
Telephone Number : 605-390-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2006
Last Update Date : 03/11/2026

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