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General NPI Number Information
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NPI Number | 1447248810
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Entity Type | Organization
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Legal Business Name | BRENHAM FAMILY PRACTICE AND OBSTETRICS PA
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 601 MEDICAL PKWY STE D
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City | BRENHAM
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State | TX
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Zip | 77833-5429
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Country | US
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Telephone | 979-836-2822
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Fax | 979-836-1943
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Provider Business Mailing Address
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Address Line | 601 MEDICAL PKWY STE D
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City | BRENHAM
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State | TX
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Zip | 77833-5429
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Country | US
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Telephone | 979-836-2822
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Fax | 979-836-1943
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Authorized Official
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Title or Position | OWNER
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Name | DR. JON F BODE
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Credential | MD
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Telephone | 979-836-2822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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