| Doctor Name: | BERTRAND BODO |
| NPI Number: | 1013379304 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | AP130666 |
| Business Practice Address: | 4515 Marsha Sharp Fwy Lubbock, TX - 794072520 |
| Business Phone Number: | 8067447223 |
| Business Fax Number: | 8067403325 |
| Mailing Address: | 2804 N Loop 289, LUBBOCK |
| State: | TX |
| Postal Code: | 794151410 |
| Phone Number: | 8067447223 |
| Fax Number: | 8067403325 |
| NPI Enumeration Date: | 03/24/2016 |
| NPI Last Update Date: | 04/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | AP130666 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |