MEDICARE: CODY BOONE MCLEOD 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	207X00000X	Orthopaedic Surgery Physician	E13754	AR
2	207X00000X	Orthopaedic Surgery Physician	69200	AZ

General Provider Information

NPI Number	:	1699270611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY BOONE MCLEOD MD

Provider Business Mailing Address
First Line	:	4642 N 31ST ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5013
Country	:	US
Telephone Number	:	870-403-7454
Fax Number	:

Provider Business Practice Location Address
First Line	:	5080 N 40TH ST STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2158
Country	:	US
Telephone Number	:	602-952-8111
Fax Number	:

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

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	04/18/2024

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Directions to “ CODY BOONE MCLEOD MD” Practice Location

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