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DR. MARC E BODDICKER MD

Physicians Dermatology

Provider NPI: 1235103060

Provider Information:
DR. MARC E BODDICKER MD
Gender: M
Not Sole Proprietor

Practice Location:
710 SAINT ANNE ST  RAPID CITY, SD 57701-4670 US
Tel: 605-343-8000  Fax: 605-341-8575

Business Mailing Address:
PO BOX 3468  RAPID CITY, SD 57709-3468 US
Tel: 605-343-8000  Fax: 605-341-8575

NPI Information:
NPI: 1235103060
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207N00000XPhysicians
Dermatology
SD1485
N207ND0101XPhysicians
Dermatology
SD1485
N207ND0900XPhysicians
Dermatology
SD1485
N207NS0135XPhysicians
Dermatology
SD1485

Other Provider Identifiers:

IssuerNumberStateType
5900162SD05
RR MEDICARE070013291SD01
NE MEDICAID41192855200SD01



American Medical Association 2012 taxonomy code information

Code: 207N00000X

Type:

Classification:



Definition:



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