Provider Demographics
NPI:1861783144
Name:BODMAN, ALEXA (MD)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:BODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N IH 35 STE 600
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1850
Mailing Address - Country:US
Mailing Address - Phone:512-306-1323
Mailing Address - Fax:
Practice Address - Street 1:3000 N IH 35 STE 600
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1850
Practice Address - Country:US
Practice Address - Phone:512-306-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1983207T00000X
GA80053207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty