Healthcare Provider Details

I. General information

NPI: 1972687093
Provider Name (Legal Business Name): STELIAN PAUL BODEA-BAROTHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11797 SOUTH FWY SUITE 338
BURLESON TX
76028-7026
US

IV. Provider business mailing address

11797 SOUTH FWY SUITE 338
BURLESON TX
76028-7026
US

V. Phone/Fax

Practice location:
  • Phone: 817-293-3222
  • Fax:
Mailing address:
  • Phone: 817-293-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD33847
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM5062
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberM5062
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: