Provider Demographics
NPI:1073891081
Name:PETER R. BODNAR, M.D. PLLC
Entity Type:Organization
Organization Name:PETER R. BODNAR, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BODNAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-333-7723
Mailing Address - Street 1:6544 E CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2117
Mailing Address - Country:US
Mailing Address - Phone:520-333-7723
Mailing Address - Fax:520-333-3113
Practice Address - Street 1:6544 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2117
Practice Address - Country:US
Practice Address - Phone:520-333-7723
Practice Address - Fax:520-333-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ255152084N0400X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty