Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 035566 | GA |
NPI | 1134234990 |
---|---|
Provider Name | Dr. Scott D. Boden |
First Address | Atlanta, GA 30329-2208 |
Second Address | Atlanta, GA 30329-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F34115 | (02) | GA |