| Doctor Name: | MR. JOHN HEBER BODEN |
| NPI Number: | 1114997418 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 23537 |
| Business Practice Address: | 171 Ashley Ave Charleston, SC - 294258905 |
| Business Phone Number: | 8437921414 |
| Business Fax Number: | |
| Mailing Address: | Po Box 751461, CHARLESTON |
| State: | SC |
| Postal Code: | 282751461 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2006 |
| NPI Last Update Date: | 06/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 23537 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |