Provider Demographics
NPI:1811960156
Name:BODENSTEIN, CARL JAY (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:JAY
Last Name:BODENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:STE 336C
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-455-8855
Mailing Address - Fax:509-455-8383
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:STE 336C
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-455-8855
Practice Address - Fax:509-455-8383
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000206512080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA10004603OtherREGENCE BLUE S. OF IDAHO
WA911922781OtherPHCO
WA911922781OtherCIGNA
WABO6528OtherASURIS NW HEALTH
WA911922781OtherPREMERA
WA911922781Medicaid
WA8458507Medicaid
WAKA345OtherBLUE CROSS OF IDAHO
ID000038801Medicaid
OR205997Medicaid
MT0000108137Medicaid
WA5404342OtherAETNA
WA911922781OtherUNITED HEALTH CARE
WA911922781OtherGROUP HEALTH NW