Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01036318A | IN |
Y | 111NI0900X | Internist | 01036318A | IN |
N | 207RI0200X | Infectious Disease | 01036318A | IN |
NPI | 1043220080 |
---|---|
Provider Name | Robert B. Bode |
First Address | Richmond, IN 47374-1157 |
Second Address | Richmond, IN 47374-1919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 24/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000676852 | ANTHEM (RPA) (01) | IN |
200007930 | (05) | IN |