Provider Demographics
NPI:1083762389
Name:BODNAR, PETER R (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:BODNAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2022-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ255152084N0400X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine