Provider Demographics
NPI:1689885402
Name:V DOUGLAS JODOIN MD INC
Entity Type:Organization
Organization Name:V DOUGLAS JODOIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:V DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JODOIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-773-3950
Mailing Address - Street 1:39000 BOB HOPE DR STE W208
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-7013
Mailing Address - Country:US
Mailing Address - Phone:760-773-3950
Mailing Address - Fax:
Practice Address - Street 1:39000 BOB HOPE DR STE W208
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-7013
Practice Address - Country:US
Practice Address - Phone:760-773-3950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40824208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD33318Medicare UPIN