MEDICARE: JOSEPH F BODIN III PA-AA

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	207L00000X	Anesthesiology Physician	AA-828	AL
2	367H00000X	Anesthesiologist Assistant	007524	GA

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
2	051530656	OTHER	AL	BC OF ALABAMA

General Provider Information

NPI Number	:	1689659179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH F BODIN III PA-AA

Provider Business Mailing Address
First Line	:	PO BOX 551420
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33355-1420
Country	:	US
Telephone Number	:	800-243-3839
Fax Number	:	855-851-4405

Provider Business Practice Location Address
First Line	:	777 HEMLOCK ST
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31201-2102
Country	:	US
Telephone Number	:	866-507-5244
Fax Number	:	855-851-4405

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/21/2015

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Directions to “ JOSEPH F BODIN III PA-AA” Practice Location

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