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General NPI Number Information
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NPI Number | 1811191687
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Entity Type | Individual
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Provider Name | FLOYD BODDEN PA
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Gender | Male
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 2823 FRESNO STREET
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City | FRESNO
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State | CA
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Zip | 93721-1324
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Country | US
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Telephone | 559-499-6439
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Fax | 559-499-6441
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Provider Business Mailing Address
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Address Line | 155 N. FRESNO STREET SUITE 206
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City | FRESNO
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State | CA
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Zip | 93701-2302
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Country | US
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Telephone | 559-499-6443
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Fax | 559-499-6441
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 999
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13593
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License Number State | CA
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