| Organization Name: | E. JAMES BODMER, D.P.M., PC |
| NPI Number: | 1245423219 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWARD JAMES BODMER (PRESIDENT) |
| Mailing Address: | 9765 E Dead Sure Pl Gold Canyon |
| State: | AZ US |
| Postal Code: | 852187176 |
| Phone Number: | 4803633066 |
| Fax Number: | |
| NPI Enumeration Date: | 08/23/2007 |
| NPI Last Update Date: | 08/23/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 0152 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |