Healthcare Provider Details

I. General information

NPI: 1316944697
Provider Name (Legal Business Name): DAVID J BODNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MASK RD
BROOKS GA
30205-2214
US

IV. Provider business mailing address

1010 N 102ND ST STE 201
OMAHA NE
68114-2122
US

V. Phone/Fax

Practice location:
  • Phone: 833-228-6889
  • Fax: 877-853-0376
Mailing address:
  • Phone: 833-228-6889
  • Fax: 877-853-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number23913
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16259C
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2024026884
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMC-185
License Number StateGU
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20363
License Number StateND
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC195626
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036687
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: