Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D0051703 | MD |
NPI | 1386665735 |
---|---|
Provider Name | Jeffrey T Brodie |
First Address | Towson, MD 21204-2065 |
Second Address | Towson, MD 21204-2065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 11/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
847703500 | (05) | MD |
G33663 | (02) |