MEDICARE: ROBERT P ODGERS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	23209	TX

General Provider Information

NPI Number	:	1053300350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT P ODGERS PHD

Provider Business Mailing Address
First Line	:	1814 8TH AVE
Second Line	:	B
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1354
Country	:	US
Telephone Number	:	817-335-5565
Fax Number	:	817-335-5787

Provider Business Practice Location Address
First Line	:	1814 8TH AVE
Second Line	:	B
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1354
Country	:	US
Telephone Number	:	817-335-5565
Fax Number	:	817-335-5787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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