MEDICARE: DR. LEROY ODOM MD

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	207RG0100X	Gastroenterology Physician	F6295	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144274234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEROY ODOM MD

Provider Business Mailing Address
First Line	:	2101 CRAWFORD
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77002-9014
Country	:	US
Telephone Number	:	713-658-8660
Fax Number	:	713-658-0205

Provider Business Practice Location Address
First Line	:	2101 CRAWFORD ST STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-8941
Country	:	US
Telephone Number	:	713-658-8660
Fax Number	:	713-658-0205

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

Provider Enumeration Date	:	05/21/2006
Last Update Date	:	09/30/2022

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