Individual
LINDA P BRODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6426
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6426
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
35051515B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01370744
—
MS
05
—
0581133
—
OH
Enumeration date
07/28/2005
Last updated
08/29/2013
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