Provider Demographics
NPI:1457333429
Name:BRODE, JAMES WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:BRODE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7275 E SOUTHGATE DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2628
Mailing Address - Country:US
Mailing Address - Phone:916-427-5881
Mailing Address - Fax:916-427-8892
Practice Address - Street 1:7275 E SOUTHGATE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2628
Practice Address - Country:US
Practice Address - Phone:916-427-5881
Practice Address - Fax:916-427-8892
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00G278170207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G278170Medicaid
CA00G278170Medicaid