DR. JOHN R BODKER M.D., NPI 1457319642 — PHOENIX (AZ)

NPI 1457319642

13+ Years Experience Individual

DR. JOHN R BODKER M.D.

05.04.2006
PROVIDER ENUMERATION DATE
04.04.2015
LAST UPDATE DATE
1457319642
NPI NUMBER

About DR. JOHN R BODKER

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

DR. JOHN R BODKER is a provider established in PHOENIX, AZ. The NPI number of DR. JOHN R BODKER is 1457319642 and was assigned on 05.04.2006. The practitioners primary taxonomy code is: 2085N0904X with license number: 13615 AZ .

Mailing address

  • City: PHOENIX
  • State: AZ
  • Postal code: 850041042
  • Phone: 6022741919
  • Fax: 6022740804
  • Address: 2830 N 3RD ST

Primary Practice Address

  • Region : PHOENIX, AZ
  • NPI : 1457319642
  • Phone : 6022741919
  • Fax : 6022740804
  • Postalcode : 850041042
  • Address : 2830 N 3RD ST

Additional identifiers

  • Identifier: 1Z7049
  • Code / Type : 1 - other
  • Identifier state : AZ
  • Identifier issuer: HEALTHNET

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 245789
  • Code / Type : 1 - other
  • Identifier state : AZ
  • Identifier issuer : AHCCCS

Provider taxonomy - Radiology

  • Taxonomy code: 2085N0904X
  • License number: 13615
  • License state: AZ

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A radiologist who is involved in the analysis and imaging of radionuclides and radiolabeled substances in vitro and in vivo for diagnosis and the administration of radionuclides and radiolabeled substances for the treatment of disease.

Contacts:

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  • DR. JOHN R BODKER M.D.
  • Address : 2830 N 3RD ST
  • Region : PHOENIX, AZ
  • NPI : 1457319642
  • Phone : 6022741919
  • Fax : 6022740804
  • Postalcode : 850041042

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address2830 N 3RD ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePHOENIX
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameAZ
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code850041042
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number6022741919
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number6022740804
The fax number associated with the location address of the provider being identified.
NPI1457319642
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 12085N0904X
A radiologist who is involved in the analysis and imaging of radionuclides and radiolabeled substances in vitro and in vivo for diagnosis and the administration of radionuclides and radiolabeled substances for the treatment of disease.
Provider Enumeration Date05.04.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated04.04.2015
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)DR. JOHN R BODKER
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address2830 N 3RD ST
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NamePHOENIX
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameAZ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code850041042
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number6022741919
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number6022740804
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #12085N0904X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Radiology
A radiologist who is involved in the analysis and imaging of radionuclides and radiolabeled substances in vitro and in vivo for diagnosis and the administration of radionuclides and radiolabeled substances for the treatment of disease.
Provider License Number 113615
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1AZ
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 11Z7049
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1AZ
Other Provider Identifier State #1
Other Provider Identifier Issuer 1HEALTHNET
Other Provider Identifier Issuer #1
Other Provider Identifier 2245789
Other Provider Identifier #2
Other Provider Identifier Type 21
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2AZ
Other Provider Identifier State #2
Other Provider Identifier Issuer 2AHCCCS
Other Provider Identifier Issuer #2
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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