Boden James Port, DO

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

02008108A Issued in IN

Practice address

307 Boatner Rd Ste 114
Eglin Afb, FL 32542-1302

Phone

(850) 883-8600

NPI assigned

Mar 22, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783468800000",
    "number": "1003519919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302",
            "telephone_number": "850-883-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORT",
        "first_name": "BODEN",
        "middle_name": "JAMES",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-22",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "02008108A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lien My Thi Phan, PHARM.D
• Thomas Reger Piazza, M.D.
• Kristine Pierce, MD
• Anjeli Kristen Nayar Pope, M.D.
• Jennifer Lynn Pope, IDMT
• Jayce Porter, D.O.
• Dylan Preister, IDMT
• Crystal Earl Price, PHARMD
• Micah J Price, PSY.D.
• Lewis Pulley

• General Practice Physician in Eglin Afb, FL
• Providers in Eglin Afb, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.