Jeffrey Bodwin, MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

G46166 Issued in CA

Practice address

100 E Valencia Mesa Dr
Suite 105
Fullerton, CA 92835-3813

Phone

(714) 446-5640

Fax

(714) 446-5625

NPI assigned

Sep 20, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366934400000",
    "number": "1932195476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "279 IMPERIAL HWY",
            "address_2": "SUITE 730",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928351041",
            "telephone_number": "714-449-4841",
            "fax_number": "714-449-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR",
            "address_2": "SUITE 105",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353813",
            "telephone_number": "714-446-5640",
            "fax_number": "714-446-5625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODWIN",
        "first_name": "JEFFREY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2013-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G46166",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CA",
            "license": "G46166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia A Bock, COTA/L
• Nadine Boctor
• Laura Boden, OTD
• Sylvia Sue Boden, L.C.S.W.
• John Marius Bodnar, DMD - RETIRED
• Amara Boerner, MS, OTR/L
• Madison Grace Boetsch, TRAINEE
• Catherine Louise Bogardus
• Richard Boghossian, DC
• Shawna Bohannon Browne, LCSW

• Endocrinology, Diabetes & Metabolism Physician in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Endocrinology, Diabetes & Metabolism Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2013; 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.