MEDICARE: DR. RICHARD H ODELL 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	207N00000X	Dermatology Physician	207N00000X	UT

General Provider Information

NPI Number	:	1215999875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD H ODELL MD

Provider Business Mailing Address
First Line	:	1345 E 3900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1474
Country	:	US
Telephone Number	:	801-272-4219
Fax Number	:	801-274-8565

Provider Business Practice Location Address
First Line	:	1345 E 3900 S STE 110
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-4403
Country	:	US
Telephone Number	:	801-272-4219
Fax Number	:	801-274-8565

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	01/21/2020

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