MEDICARE: DR. BO SONG 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	208100000X	Physical Medicine & Rehabilitation Physician	2021022115	MO
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	T7049	TX
3	208100000X	Physical Medicine & Rehabilitation Physician	T7049	TX

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
2	1427581446	OTHER	TX	NPI

General Provider Information

NPI Number	:	1427581446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BO SONG MD

Provider Business Mailing Address
First Line	:	6560 FANNIN ST STE 1878
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2752
Country	:	US
Telephone Number	:	713-441-5189
Fax Number	:	713-441-5189

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 1878
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2752
Country	:	US
Telephone Number	:	713-441-5189
Fax Number	:	713-441-5189

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	03/07/2023

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Directions to “ DR. BO SONG MD” Practice Location

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