MEDICARE: DR. JAMES ALLEN O'DONNELL 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	207VG0400X	Gynecology Physician	21798	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	COAAA1927	OTHER	CO	MEDICARE ID

Other Identifiers

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

General Provider Information

NPI Number	:	1699721738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ALLEN O'DONNELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81602-0190
Country	:	US
Telephone Number	:	970-379-1586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 BLAKE AVE
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4275
Country	:	US
Telephone Number	:	970-945-8503
Fax Number	:	970-947-9048

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/14/2016

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