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General NPI Number Information
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NPI Number | 1053388637
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Entity Type | Individual
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Provider Name | GORDON A. BODZIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 9500 MENTOR AVE STE 200
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City | MENTOR
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State | OH
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Zip | 44060-8702
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Country | US
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Telephone | 440-354-1899
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Fax | 440-354-1845
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Provider Business Mailing Address
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Address Line | 5105 SOM CENTER RD #107
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City | MENTOR
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State | OH
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Zip | 44060
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Country | US
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Telephone | 440-953-5712
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Fax | 440-953-5713
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 36446
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A88984
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35.121334
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License Number State | OH
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