Provider Demographics
NPI:1225016074
Name:JODOIN, V DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:V DOUGLAS
Middle Name:
Last Name:JODOIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:W208
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-773-3950
Mailing Address - Fax:760-779-8639
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:W208
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-773-3950
Practice Address - Fax:760-779-8639
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G40824Medicare ID - Type Unspecified
D33318Medicare UPIN