Provider Demographics
NPI:1013031913
Name:BODLE, JANET (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:BODLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100A DRAKE'S LANDING ROAD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-3032
Mailing Address - Country:US
Mailing Address - Phone:415-924-1214
Mailing Address - Fax:415-924-1375
Practice Address - Street 1:100A DRAKE'S LANDING ROAD
Practice Address - Street 2:SUITE 225
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-3032
Practice Address - Country:US
Practice Address - Phone:415-924-1214
Practice Address - Fax:415-924-1375
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG030961208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice