Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2963 | CA |
Y | 222Z00000X | Podiatrist | E2963 | CA |
N | 213ES0131X | Foot Surgery | 2031 | NV |
N | 213ES0131X | Foot Surgery | E2963 | CA |
NPI | 1376578351 |
---|---|
Provider Name | Paul J. Brody |
First Address | Culver City, CA 90232-2751 |
Second Address | Culver City, CA 90232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 17/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2031 | STATE LICENSE NUMBER (01) | NV |
E2963 | STATE LICENSE NUMBER (01) | CA |