Provider Demographics
NPI:1639283781
Name:BODMAN, UZI (MD)
Entity Type:Individual
Prefix:DR
First Name:UZI
Middle Name:
Last Name:BODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 NE 40TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6411
Mailing Address - Country:US
Mailing Address - Phone:954-540-4689
Mailing Address - Fax:
Practice Address - Street 1:3305 NE 40TH ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6411
Practice Address - Country:US
Practice Address - Phone:954-540-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0025342207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94462Medicare ID - Type UnspecifiedMEDICARE
FLA24940Medicare UPIN