Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME70692 | FL |
NPI | 1093702045 |
---|---|
Provider Name | Dr. John Andrew Odell |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 06/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31599 | BLUECROSS/BLUESHIELD (01) | FL |
780000637 | RAILROAD MEDICARE (01) | FL |
F76580 | (02) | FL |