Walter G. Bodjanac, DO, LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

34005512 Issued in OH

Legal business name

WALTER G. BODJANAC, DO, LLC

Practice address

770 Balgreen Dr
Suite 109
Mansfield, OH 44906-4106

Phone

(419) 756-9996

NPI assigned

Feb 26, 2008

Last updated

Feb 26, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Raun D Skyrm

Title

Administrator

Phone

(330) 773-3544

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Morris Wade Pulliam, M.D.

  • Neurological Surgery Physician
  • Cortland, OH
  • NPI 1811976087
  NPD (past)
• Walter Bodjanac, D.O.

  • Plastic Surgery Physician
  • Scottsdale, AZ
  • NPI 1376525188
  NPD (past)
• David Brian Dellinger, DO

  • Plastic and Reconstructive Surgery Physician
  • Austin, TX
  • NPI 1093785404

  Plastic Surgery

  NPD (past)

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203984000000",
    "number": "1093984767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "358 BIRCH ST",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443012602",
            "telephone_number": "330-773-3544",
            "fax_number": "330-773-3698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 BALGREEN DR",
            "address_2": "SUITE 109",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449064106",
            "telephone_number": "419-756-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER G. BODJANAC, DO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2008-02-26",
        "status": "A",
        "authorized_official_last_name": "SKYRM",
        "authorized_official_first_name": "RAUN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "330-773-3544"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OH",
            "license": "34005512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystalshae Leann Wallace
• Kole Wallace
• Raisa Lepa Wallace
• Cynthia Ann Wallis, LISW
• Walter E Glenn DDS Inc
• Philip W. Walter, D.D.S.
• Jeffrey M. Walthour, PHARM.D.
• Nathaniel A Walton, AA
• Brianna Walz, LPN
• Kelly E Warner

• Plastic Surgery Physician in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Plastic Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.