Organization
BODAVULA PEDIATRICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHANI BODAVULA MD (OWNER)
(314) 620-5823
Entity
Organization
Contact information
Practice address
6448 BROADWAY BLVD, GARLAND, TX 75043-7504
(972) 216-8500
(972) 216-8521
Mailing address
6448 BROADWAY BLVD, GARLAND, TX 75043-5943
(972) 216-8500
(972) 216-8521
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32070567899
TEXAS PAYER NO
TX
05
—
32070567899
—
TX
Enumeration date
05/16/2019
Last updated
09/20/2025
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