MEDICARE: DR. ERICA PATRESE ODUM M.D.

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	208000000X	Pediatrics Physician	00000	TN

General Provider Information

NPI Number	:	1558365429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA PATRESE ODUM M.D.

Provider Business Mailing Address
First Line	:	1665 BONNIE LN
Second Line	:	SUITE 101
City	:	CORDOVA
State	:	TN
Zip	:	38016-0548
Country	:	US
Telephone Number	:	901-531-8555
Fax Number	:	901-531-8560

Provider Business Practice Location Address
First Line	:	1665 BONNIE LN
Second Line	:	SUITE 101
City	:	CORDOVA
State	:	TN
Zip	:	38016-0548
Country	:	US
Telephone Number	:	901-531-8555
Fax Number	:	901-531-8560

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/28/2011

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