Healthcare Provider Details

I. General information

NPI: 1053300350
Provider Name (Legal Business Name): ROBERT P ODGERS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SE CENTRAL PKWY STE 224
STUART FL
34994-5916
US

IV. Provider business mailing address

10 SE CENTRAL PKWY STE 224
STUART FL
34994-5916
US

V. Phone/Fax

Practice location:
  • Phone: 772-291-2905
  • Fax: 772-291-2906
Mailing address:
  • Phone: 772-291-2905
  • Fax: 772-291-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number7944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: