MEDICARE: DR. JASON MICHAEL BODIFORD 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207L00000X	Anesthesiology Physician	R6344	TX

General Provider Information

NPI Number	:	1639411184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON MICHAEL BODIFORD MD

Provider Business Mailing Address
First Line	:	6431 FANNIN ST
Second Line	:	MSB 4.020
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-500-7200
Fax Number	:	713-500-7213

Provider Business Practice Location Address
First Line	:	6431 FANNIN ST
Second Line	:	MSB 4.020
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-500-7200
Fax Number	:	713-500-7213

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

Provider Enumeration Date	:	03/22/2013
Last Update Date	:	01/27/2026

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