Provider Demographics
NPI:1679579908
Name:BRAUER, BODO (MD)
Entity Type:Individual
Prefix:DR
First Name:BODO
Middle Name:
Last Name:BRAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8555 MEMORIAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-7001
Mailing Address - Country:US
Mailing Address - Phone:409-237-6480
Mailing Address - Fax:833-749-0330
Practice Address - Street 1:8555 MEMORIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-7001
Practice Address - Country:US
Practice Address - Phone:409-237-6480
Practice Address - Fax:833-749-0330
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine