Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | G54886 | CA |
NPI | 1275563561 |
---|---|
Provider Name | Dr. Gordon Brody |
First Address | Redwood City, CA 94063 |
Second Address | Redwood City, CA 94063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A52818 | (02) |