Basic Information
| Provider Information | |||||||||
| NPI: | 1720501919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BODINE | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 MASON ST | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700537025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044513923 | ||||||||
| FaxNumber: | 5044513923 | ||||||||
| Practice Location | |||||||||
| Address1: | 1516 JEFFERSON HWY | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701212429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048425344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2017 | ||||||||
| LastUpdateDate: | 07/20/2017 | ||||||||
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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 | 367500000X | RN128601 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.