Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 27197 | SC |
N | 207X00000X | Orthopaedic Surgeon | ME103720 | FL |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 27197 | SC |
NPI | 1174733125 |
---|---|
Provider Name | Jason B O'dell |
First Address | Florence, SC 29502-3239 |
Second Address | Florence, SC 29506-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 15/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00052500 | (05) | FL |
21464 | (05) | LA |
23163 | BCBS (01) | FL |
271976 | (05) | SC |
329791 | AVMED (01) | FL |
9234356 | AETNA (01) | FL |
9250826 | CIGNA (01) | FL |
AA52471271 | (02) | SC |