Healthcare Provider Details

I. General information

NPI: 1639118953
Provider Name (Legal Business Name): FRANK ALPHONSO ODLUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9149 ESTATE THOMAS PARAGON MEDICAL BUILDING, SUITE 302
ST THOMAS VI
00802-2687
US

IV. Provider business mailing address

PO BOX 12138
ST THOMAS VI
00801-5138
US

V. Phone/Fax

Practice location:
  • Phone: 340-777-8599
  • Fax: 340-777-9927
Mailing address:
  • Phone: 340-777-8599
  • Fax: 340-777-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1036
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: