Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | MD-43501 | IA |
N | 2080P0204X | Pediatric Emergency Doctor | ME123608 | FL |
NPI | 1245641240 |
---|---|
Provider Name | John Odome |
First Address | Des Moines, IA 50314-2613 |
Second Address | Des Moines, IA 50314-2613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 30/03/2020 |