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General NPI Number Information
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NPI Number | 1457498107
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Entity Type | Organization
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Legal Business Name | T. GERALD O'DANIEL M.D., PLLC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 222 S 1ST ST SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40202-1350
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Country | US
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Telephone | 502-584-1109
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Fax | 502-589-6882
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Provider Business Mailing Address
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Address Line | 222 S 1ST ST SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40202-1350
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Country | US
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Telephone | 502-584-1109
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Fax | 502-589-6882
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. T. GERALD O'DANIEL
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Credential | M.D., PLLC
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Telephone | 502-584-1109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 24070
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License Number State | KY
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