Healthcare Provider Details

I. General information

NPI: 1376525188
Provider Name (Legal Business Name): WALTER BODJANAC D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N CIVIC CENTER PLZ
SCOTTSDALE AZ
85251-6413
US

IV. Provider business mailing address

1932 E VILLA LINDA DR
PHOENIX AZ
85024-0102
US

V. Phone/Fax

Practice location:
  • Phone: 480-994-1333
  • Fax:
Mailing address:
  • Phone: 419-612-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number34-00-5512-B
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34-00-5512-B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: