John Boden MD LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME94719 Issued in FL

Legal business name

JOHN BODEN MD LLC

Practice address

6879 US Highway 98 W
Santa Rosa Beach, FL 32459-3257

Phone

(850) 502-1363

Fax

(850) 837-4837

NPI assigned

Aug 15, 2008

Organization subpart

No

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

Authorized official

Name

Dr. John M Boden, M.D.

Title

President/Physician

Phone

(850) 502-1363

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1218758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229904000000",
    "number": "1275789711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 INDIAN BAYOU DR",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325414447",
            "telephone_number": "850-502-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6879 US HIGHWAY 98 W",
            "city": "SANTA ROSA BEACH",
            "state": "FL",
            "postal_code": "324593257",
            "telephone_number": "850-502-1363",
            "fax_number": "850-837-4837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN BODEN MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-15",
        "last_updated": "2008-12-22",
        "status": "A",
        "authorized_official_last_name": "BODEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "850-502-1363",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME94719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009912339",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044554100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009912342",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert L Ignasiak Jr., MD
• Imaging Institute LLC
• Inchargeclinic
• Baylee Jaynes
• Elizabeth Holland Jenkins
• Ariel Johnson
• Erin D Johnson, NP-C
• Kayla Johnson
• Keri J Jones Matheus, W.H.N.P.
• Journey Bravely

• Internal Medicine Physician in Santa Rosa Beach, FL
• Providers in Santa Rosa Beach, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.