Healthcare Provider Details

I. General information

NPI: 1154626109
Provider Name (Legal Business Name): JAMES A O'DONNELL, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 SUNNY ACRES RD
GLENWOOD SPRINGS CO
81601-2886
US

IV. Provider business mailing address

PO BOX 190
GLENWOOD SPRINGS CO
81602-0190
US

V. Phone/Fax

Practice location:
  • Phone: 970-379-1586
  • Fax:
Mailing address:
  • Phone: 970-379-1586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number21798
License Number StateCO

VIII. Authorized Official

Name: DR. JAMES A O'DONNELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 970-379-1586