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General NPI Number Information
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NPI Number | 1164449674
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Entity Type | Individual
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Provider Name | MATTHEW S BODNER MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 5 GILMER PKWY SUITE 1
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City | TALLASSEE
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State | AL
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Zip | 36078-1215
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Country | US
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Telephone | 334-731-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 5 GILMER PKWY SUITE 1
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City | TALLASSEE
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State | AL
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Zip | 36078-1215
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Country | US
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Telephone | 334-731-4500
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | R5J60
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 10657
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 50121-20
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License Number State | WI
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