Provider Demographics
NPI:1457608051
Name:BODEKER, TRAVIS (DPM)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:BODEKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 N SAM HOUSTON PKWY E
Mailing Address - Street 2:STE 150
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4693
Mailing Address - Country:US
Mailing Address - Phone:281-973-5237
Mailing Address - Fax:832-412-2016
Practice Address - Street 1:9701 N SAM HOUSTON PKWY E
Practice Address - Street 2:STE 150
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4693
Practice Address - Country:US
Practice Address - Phone:281-973-5237
Practice Address - Fax:832-412-2016
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2147213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery