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General NPI Number Information
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NPI Number | 1700878691
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Entity Type | Individual
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Provider Name | STEPHEN RICHARD BODEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 390 N MAIN ST
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6046
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Country | US
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Telephone | 801-397-6300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27128
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City | SLC
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State | UT
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Zip | 84127-0128
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Country | US
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Telephone | 801-397-6300
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 12974480-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 12974480-1205
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License Number State | UT
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