Healthcare Provider Details

I. General information

NPI: 1306124086
Provider Name (Legal Business Name): ROBERT ODELL MD PHD MEDICAL ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8084 W SAHARA AVE SUITE E
LAS VEGAS NV
89117-2073
US

IV. Provider business mailing address

3540 W SAHARA AVE 368
LAS VEGAS NV
89102-5816
US

V. Phone/Fax

Practice location:
  • Phone: 702-257-7246
  • Fax: 702-254-7044
Mailing address:
  • Phone: 702-257-7246
  • Fax: 702-254-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT H ODELL JR.
Title or Position: OWNER
Credential: MD
Phone: 702-257-7246