Provider Demographics
NPI:1033784848
Name:CHRISTIANSON, BODEN JAMES (DO)
Entity type:Individual
Prefix:
First Name:BODEN
Middle Name:JAMES
Last Name:CHRISTIANSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36TH MEDICAL GROUP UNIT 14010 BLDG. 26012, ANDERSEN AFB
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96543-4003
Mailing Address - Country:US
Mailing Address - Phone:671-366-2967
Mailing Address - Fax:
Practice Address - Street 1:36TH MEDICAL GROUP UNIT 14010 BLDG. 26012, ANDERSEN AFB
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96543-4003
Practice Address - Country:US
Practice Address - Phone:671-366-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2877207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOYBC19K110304OtherBLUECROSS BLUESHIELD