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General NPI Number Information
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NPI Number | 1194178608
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Entity Type | Organization
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Legal Business Name | FALL CREEK FOOT & ANKLE PLLC
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 9701 N SAM HOUSTON PKWY E SUITE 150
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City | HUMBLE
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State | TX
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Zip | 77396-4693
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Country | US
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Telephone | 281-973-5237
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Fax | 832-412-2016
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Provider Business Mailing Address
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Address Line | 9701 N SAM HOUSTON PKWY E SUITE 150
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City | HUMBLE
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State | TX
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Zip | 77396-4693
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Country | US
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Telephone | 281-973-5237
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Fax | 832-412-2016
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRAVIS SCOTT BODEKER
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Credential | DPM
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Telephone | 281-973-5237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 2147
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License Number State | TX
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