Healthcare Provider Details

I. General information

NPI: 1205035086
Provider Name (Legal Business Name): DAVID MALCOLM ODOM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E TAHQUITZ CANYON WAY SUITE 108
PALM SPRINGS CA
92262-6982
US

IV. Provider business mailing address

3001 E TAHQUITZ CANYON WAY SUITE 108
PALM SPRINGS CA
92262-6982
US

V. Phone/Fax

Practice location:
  • Phone: 858-900-1288
  • Fax: 866-598-2420
Mailing address:
  • Phone: 858-900-1288
  • Fax: 866-598-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1288
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC33440
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number1288
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC33440
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberC33440
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberC33440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: