Provider Demographics
NPI:1225054695
Name:BODTKER, ERIK R (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:R
Last Name:BODTKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3717 COTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-0664
Mailing Address - Country:US
Mailing Address - Phone:406-624-6329
Mailing Address - Fax:
Practice Address - Street 1:915 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6902
Practice Address - Country:US
Practice Address - Phone:800-461-3981
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8414207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071292Medicaid
NMP01790452OtherRAILROAD MEDICARE
MT134310888OtherNEW WEST & HLTH CONNECT
MT0148772Medicaid
MT1343108880000OtherCHAMPUS
NM67432514Medicaid
MT000091916OtherBLUE CROSS OF MONTANA
UT1225054695Medicaid
MT000091916OtherBLUE CROSS OF MONTANA
NM457320YTR2Medicare PIN