MEDICARE: STACEY J ODDMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME87585	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003921222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY J ODDMAN MD

Provider Business Mailing Address
First Line	:	8100 SW 10TH ST FL 3
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3279
Country	:	US
Telephone Number	:	305-689-3627
Fax Number	:

Provider Business Practice Location Address
First Line	:	8100 SW 10TH ST FL 3
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3279
Country	:	US
Telephone Number	:	305-689-3627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	05/17/2022

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