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General NPI Number Information
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NPI Number | 1093984767
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Entity Type | Organization
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Legal Business Name | WALTER G. BODJANAC, DO, LLC
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 770 BALGREEN DR SUITE 109
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City | MANSFIELD
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State | OH
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Zip | 44906-4106
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Country | US
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Telephone | 419-756-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 358 BIRCH ST
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City | AKRON
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State | OH
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Zip | 44301-2602
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Country | US
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Telephone | 330-773-3544
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Fax | 330-773-3698
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAUN D SKYRM
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Credential |
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Telephone | 330-773-3544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 34005512
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License Number State | OH
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