Individual
KENNETH SPENCER BODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6301 HARRIS PKWY STE 200, FORT WORTH, TX 76132-4265
(817) 433-3450
Mailing address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 916-5586
(210) 916-5102
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
U1474
TX
207XS0117X
Orthopaedic Surgery of the Spine Physician
A122470
CA
207XS0117X
Orthopaedic Surgery of the Spine Physician
MD60635856
WA
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
U1474
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A122470
STATE LICENCE
CA
01
—
MD60635856
STATE
WA
01
—
U1474
STATE LICENSE
TX
Enumeration date
04/11/2007
Last updated
05/29/2024
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