MEDICARE: DR. ODIS WAYNE GOSSETT M.D.

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	207Q00000X	Family Medicine Physician	K2027	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00004526	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8H3101	OTHER	TX	BLUE CROSS
2	2358921	OTHER	TX	AETNA
4	04443	OTHER	TX	CIGNA

General Provider Information

NPI Number	:	1477556322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ODIS WAYNE GOSSETT M.D.

Provider Business Mailing Address
First Line	:	1039 N TWIN CITY HWY STE B
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-3851
Country	:	US
Telephone Number	:	409-722-0026
Fax Number	:	409-729-2783

Provider Business Practice Location Address
First Line	:	1039 N TWIN CITY HWY STE B
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-3851
Country	:	US
Telephone Number	:	409-722-0026
Fax Number	:	409-729-2783

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/09/2024

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Directions to “ DR. ODIS WAYNE GOSSETT M.D.” Practice Location

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