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NPI Code Detail

MEDICARE: GERALD LEWIS BRODY M.D.

MEDICARE: GERALD LEWIS BRODY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry PhysicianA018113CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A18113OTHERCAMEDICAL LICENSE

General Provider Information

NPI Number : 1366575813
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERALD LEWIS BRODY M.D.
Provider Business Mailing Address
First Line : 2052 OXBOW CT
Second Line :
City : MEADOW VISTA
State : CA
Zip : 95722-9415
Country : US
Telephone Number : 530-878-7478
Fax Number : 530-878-2558
Provider Business Practice Location Address
First Line : 11716 ENTERPRISE DR
Second Line :
City : AUBURN
State : CA
Zip : 95603-3732
Country : US
Telephone Number : 530-889-6700
Fax Number : 530-886-5415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 03/08/2026

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