Healthcare Provider Details

I. General information

NPI: 1699721738
Provider Name (Legal Business Name): JAMES ALLEN O'DONNELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4275
US

IV. Provider business mailing address

PO BOX 190
GLENWOOD SPRINGS CO
81602-0190
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-8503
  • Fax: 970-947-9048
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:
Title or Position:
Credential:
Phone: