MEDICARE: MR. CHRISTOPHER LEE CODY MD

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
1	208000000X	Pediatrics Physician	G30893	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629074570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER LEE CODY MD

Provider Business Mailing Address
First Line	:	2800 HARRIS ST
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95503-4809
Country	:	US
Telephone Number	:	707-445-8416
Fax Number	:	707-445-4182

Provider Business Practice Location Address
First Line	:	2800 HARRIS ST
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95503-4809
Country	:	US
Telephone Number	:	707-445-8416
Fax Number	:	707-445-4182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	11/08/2011

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