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General NPI Number Information
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NPI Number | 1871152447
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Entity Type | Individual
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Provider Name | ALEXANDER DIAZ BODE MD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 1364 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-4603
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Country | US
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Telephone | 404-712-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 3307 PORT ROYALE DR S APT C105
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-7952
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Country | US
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Telephone | 314-750-2592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 99982
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | TRN29568
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 99982
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License Number State | GA
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