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General NPI Number Information
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NPI Number | 1114017068
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Entity Type | Individual
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Provider Name | BRENDAN RHODES O'DONNELL
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 21616 76TH W AVE, SUITE 209
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City | EDMONDS
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State | WA
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Zip | 98026-7512
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Country | US
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Telephone | 425-774-5163
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Fax | 425-744-1705
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Provider Business Mailing Address
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Address Line | 21616 76TH W AVE 209
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City | EDMONDS
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State | WA
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Zip | 98026-7512
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Country | US
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Telephone | 425-774-5163
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Fax | 425-744-1705
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD00043309
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License Number State | WA
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