Basic Information
| Provider Information | |||||||||
| NPI: | 1497861611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BODDICKER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 8TH ST NE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193633565 | ||||||||
| FaxNumber: | 3193634001 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 8TH ST NE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193633565 | ||||||||
| FaxNumber: | 3193634001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 09/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 19024 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 19024 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 0003509 | 05 | IA | MEDICAID | 03560 | 01 | IA | BCBS | OTHER |