Healthcare Provider Details

I. General information

NPI: 1851704076
Provider Name (Legal Business Name): OLEG ODIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 DIPLOMACY DR HOSPITALIST DEPARTMENT
ANCHORAGE AK
99508-5926
US

IV. Provider business mailing address

4315 DIPLOMACY DR HOSPITALIST DEPARTMENT
ANCHORAGE AK
99508-5926
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-2354
  • Fax:
Mailing address:
  • Phone: 907-563-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127698
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17103C
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23411
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number23411
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberM-2239
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: