Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | ME95245 | FL |
NPI | 1427005081 |
---|---|
Provider Name | Thomas E Odmark |
First Address | Clearwater, FL 33756-3395 |
Second Address | Largo, FL 33773-3437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 24/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I47820 | (02) | FL |