Most Relevant Information
Provider Data
| NPI Number: | 1003519919 |
| Provider Name: | BODEN JAMES PORT DO |
| Entity Type: | Individual |
| Taxonomy Code: | 208D00000X |
| Specialty: | General Practice |
| License Number: | 02008108A |
Most Important Dates
| Enumeration Date: | 03/22/2023 |
| Last Updated: | 10/24/2024 |
Provider Practice Location
6900 ALDEN DR BLDG 160
FE WARREN AFB
WY
820052945
Practice Location Phone/Fax
| Phone: | 3077733039 |
| Fax: |
Provider Mailing Location
6900 ALDEN DR BLDG 160
FE WARREN AFB
WY
820052945
Provider Mailing Phone/Fax
| Phone: | 3077733039 |
| Fax: |