Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 9925 | AZ |
NPI | 1053365528 |
---|---|
Provider Name | Leonard Bodell |
First Address | Los Angeles, CA 90074-6765 |
Second Address | Phoenix, AZ 85004-1254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 10/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
214445 | (05) | AZ |