Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | M8542 | TX |
N | 207VX0000X | Obstetrician | M8542 | TX |
NPI | 1316116080 |
---|---|
Provider Name | Dr. Shamanique Shamaona Bodie |
First Address | Spring, TX 77373-7382 |
Second Address | Spring, TX 77373-7382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2008 |
Last Update Date | 26/02/2008 |