Provider Demographics
NPI:1821102443
Name:BRODIE, CARL JAMES III (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JAMES
Last Name:BRODIE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14100 SE 36TH ST
Mailing Address - Street 2:105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1657
Mailing Address - Country:US
Mailing Address - Phone:425-378-0110
Mailing Address - Fax:425-378-0220
Practice Address - Street 1:14100 SE 36TH ST
Practice Address - Street 2:105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1657
Practice Address - Country:US
Practice Address - Phone:425-378-0110
Practice Address - Fax:425-378-0220
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027570207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1117969Medicaid
WA8562BROtherREGENCE BLUESHIELD
WA1117969Medicaid
AB37037Medicare ID - Type Unspecified