Healthcare Provider Details

I. General information

NPI: 1841361672
Provider Name (Legal Business Name): JOHN ODEH ISSIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 9TH AVE SW SUITE 200
BESSEMER AL
35022-4527
US

IV. Provider business mailing address

975 9TH AVE SW SUITE 200
BESSEMER AL
35022-4527
US

V. Phone/Fax

Practice location:
  • Phone: 205-481-7485
  • Fax: 205-481-7494
Mailing address:
  • Phone: 205-481-7485
  • Fax: 205-481-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13626
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: