Provider Demographics
NPI:1699788943
Name:BODOR, GEZA S (MD)
Entity type:Individual
Prefix:
First Name:GEZA
Middle Name:S
Last Name:BODOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1055 CLERMONT ST
Mailing Address - Street 2:LAB 113
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3808
Mailing Address - Country:US
Mailing Address - Phone:303-399-8020
Mailing Address - Fax:303-393-4176
Practice Address - Street 1:1055 CLERMONT ST
Practice Address - Street 2:LAB 113
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3808
Practice Address - Country:US
Practice Address - Phone:303-399-8020
Practice Address - Fax:303-393-4176
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO35920207ZH0000X, 207ZP0105X, 207ZP0104X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47639369Medicaid
F62735Medicare UPIN
CO530088Medicare ID - Type Unspecified