Provider Demographics
NPI:1811017536
Name:JAMES W. BRODE, MD., INC.
Entity Type:Organization
Organization Name:JAMES W. BRODE, MD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BRODE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-427-5881
Mailing Address - Street 1:7551 TIMBERLAKE WAY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5420
Mailing Address - Country:US
Mailing Address - Phone:916-427-5881
Mailing Address - Fax:916-427-8892
Practice Address - Street 1:7551 TIMBERLAKE WAY
Practice Address - Street 2:SUITE 240
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5420
Practice Address - Country:US
Practice Address - Phone:916-427-5881
Practice Address - Fax:916-427-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG278170174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty