Provider Demographics
NPI:1700229200
Name:BODIN, JOHN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:BODIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 N WEST OAK DR UNIT 4
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-2134
Mailing Address - Country:US
Mailing Address - Phone:713-961-9148
Mailing Address - Fax:
Practice Address - Street 1:23 N WEST OAK DR UNIT 4
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-2134
Practice Address - Country:US
Practice Address - Phone:713-961-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8417207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine