Provider Demographics
NPI:1447592464
Name:BODART, AMY K (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:K
Last Name:BODART
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E CLIFF DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4700
Mailing Address - Country:US
Mailing Address - Phone:915-598-3338
Mailing Address - Fax:
Practice Address - Street 1:1225 E CLIFF DR STE 2A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4700
Practice Address - Country:US
Practice Address - Phone:915-598-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3599213ES0103X
TX2236213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery