Healthcare Provider Details

I. General information

NPI: 1699788943
Provider Name (Legal Business Name): GEZA S BODOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST LAB 113
DENVER CO
80220-3808
US

IV. Provider business mailing address

1055 CLERMONT ST LAB 113
DENVER CO
80220-3808
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax: 303-393-4176
Mailing address:
  • Phone: 303-399-8020
  • Fax: 303-393-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number35920
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number35920
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207ZP0104X
TaxonomyChemical Pathology Physician
License Number35920
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: