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General NPI Number Information
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NPI Number | 1477679405
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Entity Type | Individual
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Provider Name | JOHN BRIAN O'DONNELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 12/26/2007
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Provider Practice Location Address
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Address Line | 1920 E 3RD ST
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City | BLOOMINGTON
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State | IN
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Zip | 47401-3739
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Country | US
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Telephone | 812-336-4006
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Fax | 812-336-1960
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Provider Business Mailing Address
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Address Line | 1920 EAST THIRD STREET
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City | BLOOMINGTON
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State | IN
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Zip | 47401-3739
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Country | US
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Telephone | 812-336-4006
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Fax | 812-336-1960
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01043101
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License Number State | IN
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