Healthcare Provider Details

I. General information

NPI: 1659538734
Provider Name (Legal Business Name): RYAN WILLIAM ODEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2008
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 W BROADWAY AVE
SULPHUR OK
73086-4221
US

IV. Provider business mailing address

2007 W BROADWAY AVE
SULPHUR OK
73086-4221
US

V. Phone/Fax

Practice location:
  • Phone: 580-622-3511
  • Fax: 580-622-3513
Mailing address:
  • Phone: 580-622-3511
  • Fax: 580-622-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4673
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: