Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 5030 | NE |
N | 111NI0900X | Internist | 5030 | NE |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 25123 | NE |
NPI | 1023236213 |
---|---|
Provider Name | David E Odegaard |
First Address | Omaha, NE 68164-8117 |
Second Address | Omaha, NE 68124-2372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 13/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BO8875734 | DEA NUMBER (01) | NE |