Provider Demographics
NPI:1306895990
Name:BODE, DAVID F (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:BODE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 FLOWER ST STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3000
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:
Practice Address - Street 1:1135 S SUNSET AVE
Practice Address - Street 2:STE 100
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3937
Practice Address - Country:US
Practice Address - Phone:626-856-2215
Practice Address - Fax:626-960-2125
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC306702085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHL109627OtherX-RAY
CARHL109627OtherX-RAY
CAWC30670LMedicare PIN