Provider Demographics
NPI:1164108387
Name:BRODE, DAVID LEROY
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEROY
Last Name:BRODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 GEORGIA RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1319
Mailing Address - Country:US
Mailing Address - Phone:740-497-8315
Mailing Address - Fax:
Practice Address - Street 1:1042 GEORGIA RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1319
Practice Address - Country:US
Practice Address - Phone:740-497-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker