Provider Demographics
NPI:1316729205
Name:MBODY TEXAS PLLC
Entity type:Organization
Organization Name:MBODY TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EFOSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AIRUEHIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-999-9135
Mailing Address - Street 1:11330 LEGACY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1210
Mailing Address - Country:US
Mailing Address - Phone:469-777-4691
Mailing Address - Fax:
Practice Address - Street 1:11330 LEGACY DR STE 103
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1210
Practice Address - Country:US
Practice Address - Phone:469-777-4691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty