Healthcare Provider Details

I. General information

NPI: 1528727849
Provider Name (Legal Business Name): JEFFREY LINK BODEEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUNTRIDGE DR
COLUMBIA MO
65201-3653
US

IV. Provider business mailing address

650 HUNTRIDGE DR
COLUMBIA MO
65201-3653
US

V. Phone/Fax

Practice location:
  • Phone: 417-766-2391
  • Fax:
Mailing address:
  • Phone: 417-766-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2026024151
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: