Healthcare Provider Details

I. General information

NPI: 1861783144
Provider Name (Legal Business Name): ALEXA BODMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 12/08/2019
Certification Date: 12/08/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N IH 35 STE 600
AUSTIN TX
78705-1850
US

IV. Provider business mailing address

3000 N IH 35 STE 600
AUSTIN TX
78705-1850
US

V. Phone/Fax

Practice location:
  • Phone: 512-306-1323
  • Fax:
Mailing address:
  • Phone: 512-306-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberS1983
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: