Healthcare Provider Details

I. General information

NPI: 1083628457
Provider Name (Legal Business Name): BARBARA YOUNG BODE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE SAVAHCC
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

3601 S 6TH AVE SAVAHCC
TUCSON AZ
85723-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax: 520-629-1738
Mailing address:
  • Phone: 520-792-1450
  • Fax: 520-629-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number18507
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: