Provider Demographics
NPI:1598959611
Name:BRODIE, STEVEN GREGORY SR (MS PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GREGORY
Last Name:BRODIE
Suffix:SR
Gender:M
Credentials:MS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEDEA CREEK LN
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-1007
Mailing Address - Country:US
Mailing Address - Phone:818-917-5921
Mailing Address - Fax:
Practice Address - Street 1:8401 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-3226
Practice Address - Country:US
Practice Address - Phone:818-737-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTO471207SC0300X
CAMTP172207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics