Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G030961 | CA |
NPI | 1013031913 |
---|---|
Provider Name | Dr. Janet Bodle |
First Address | Greenbrae, CA 94904-3032 |
Second Address | Greenbrae, CA 94904-3032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2007 |
Last Update Date | 30/08/2012 |