Doctor Name: | DR. JANET BODLE |
NPI Number: | 1013031913 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | G030961 |
Business Practice Address: | 100a Drake's Landing Road Suite 225 Greenbrae, CA - 949043032 |
Business Phone Number: | 4159241214 |
Business Fax Number: | 4159241375 |
Mailing Address: | 100a Drake's Landing Road, Suite 225 GREENBRAE |
State: | CA |
Postal Code: | 949043032 |
Phone Number: | 4159241214 |
Fax Number: | 4159241375 |
NPI Enumeration Date: | 03/17/2007 |
NPI Last Update Date: | 08/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G030961 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |