Healthcare Provider Details

I. General information

NPI: 1235482175
Provider Name (Legal Business Name): ROBERT ODELL M.D., PH.D MEDICAL ENTERPRISES274413927
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

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