MEDICARE: ANTONY R. BOODY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	A80813	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A80813	OTHER	CA	CALIFORNIA MEDICAL LICENS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225079924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONY R. BOODY M.D.

Provider Business Mailing Address
First Line	:	4300 GOLDEN CENTER DR
Second Line	:	SUITE C
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-6278
Country	:	US
Telephone Number	:	530-344-2085
Fax Number	:	530-295-0400

Provider Business Practice Location Address
First Line	:	4300 GOLDEN CENTER DR
Second Line	:	SUITE C
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-6278
Country	:	US
Telephone Number	:	530-344-2085
Fax Number	:	530-295-0400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	12/17/2021

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