Provider Demographics
NPI:1316944697
Name:BODNE, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:BODNE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1010 N 102ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2122
Mailing Address - Country:US
Mailing Address - Phone:833-228-6889
Mailing Address - Fax:877-853-0376
Practice Address - Street 1:535 MASK RD
Practice Address - Street 2:
Practice Address - City:BROOKS
Practice Address - State:GA
Practice Address - Zip Code:30205-2214
Practice Address - Country:US
Practice Address - Phone:833-228-6889
Practice Address - Fax:877-853-0376
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23913174400000X
MO20240268842085R0202X
ND203632085R0202X
WY16259C2085R0202X
GUMC-1852085R0202X
GA0366872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000542264MMedicaid
AL009948040Medicaid
AL51500979OtherBLUE CROSS BLUE SHIELD AL
GAP01064288OtherRAILROAD MEDICARE
ALE73252Medicare UPIN
AL51500979OtherBLUE CROSS BLUE SHIELD AL