IndividualActive
Boden Port, DO
NPI 1003519919 · General Practice Physician · Fe Warren Afb, WY
Provider details
- NPI number
- 1003519919
- Entity type
- Individual
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Credential
- DO
- Sex
- Male
- Sole proprietor
- No
- License
- 02008108A (IN)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(59/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
6900 Alden Dr Bldg 160
Fe Warren Afb, WY 82005-2945
Phone: (307) 773-3039
Street-level locationGet directions
Mailing address
6900 Alden Dr Bldg 160
Fe Warren Afb, WY 82005-2945
Registry dates
- Enumerated
- 2023-03-22
- Last updated
- 2025-04-21
- Certified
- 2025-04-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.