Healthcare Provider Details

I. General information

NPI: 1902884836
Provider Name (Legal Business Name): DANIEL PAUL BODE AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 METAIRIE RD SUITE 101
METAIRIE LA
70005-4324
US

IV. Provider business mailing address

433 METAIRIE RD SUITE 101
METAIRIE LA
70005-4324
US

V. Phone/Fax

Practice location:
  • Phone: 504-833-4327
  • Fax: 504-833-4768
Mailing address:
  • Phone: 504-833-4327
  • Fax: 504-833-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number785
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number785
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: