BODEN JAMES PORT DO NPI 1003519919

NPI Information

  • NPI: 1003519919
  • Provider Name: BODEN JAMES PORT, DO
  • Classification: General Practice - 208D00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 6900 ALDEN DR BLDG 160
    FE WARREN AFB, WY
    ZIP 82005
  • Phone: (307) 773-3039

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NPI Details

Boden James Port, DO is a general practice in Fe Warren Afb, WY. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee Boden James Port, DO NPI is 1003519919. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

6900 ALDEN DR BLDG 160
FE WARREN AFB, WY
ZIP 82005-945
Phone: (307) 773-3039

The NPI 1003519919 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/22/2023 and was last updated on 4/21/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral Practice02008108AINDIANAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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