Provider Demographics
NPI:1891798807
Name:BODIE, BELIN FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:BELIN
Middle Name:FRED
Last Name:BODIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4300 OLD SHELL RD
Mailing Address - Street 2:STE B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2036
Mailing Address - Country:US
Mailing Address - Phone:251-342-7880
Mailing Address - Fax:251-342-8369
Practice Address - Street 1:4300 OLD SHELL RD
Practice Address - Street 2:STE B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2036
Practice Address - Country:US
Practice Address - Phone:251-342-7880
Practice Address - Fax:251-342-8369
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL6998207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00004869Medicaid
AL51004869OtherBLUE CROSS BLUE SHIELD OF AL
ALC71837Medicare UPIN
AL000004869Medicare PIN