MEDICARE: DR. DONALD RAYMOND BODEMANN MD

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	207R00000X	Internal Medicine Physician	N8250	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568425510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD RAYMOND BODEMANN MD

Provider Business Mailing Address
First Line	:	PO BOX 21850
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71903-1850
Country	:	US
Telephone Number	:	501-623-2781
Fax Number	:	501-623-1774

Provider Business Practice Location Address
First Line	:	1662 HIGDON FERRY RD
Second Line	:	SUITE 200
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6912
Country	:	US
Telephone Number	:	501-623-2781
Fax Number	:	501-623-1774

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	06/28/2016

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