MEDICARE: DR. JOSEPH J O'DONNELL 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	208600000X	Surgery Physician	08602R	LA

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
2	4601931	OTHER	LA	AETNA

General Provider Information

NPI Number	:	1508851361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH J O'DONNELL M.D.

Provider Business Mailing Address
First Line	:	4150 NELSON RD
Second Line	:	BUILDING G, SUITE 3
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4148
Country	:	US
Telephone Number	:	337-562-3732
Fax Number	:	337-562-3699

Provider Business Practice Location Address
First Line	:	4150 NELSON RD
Second Line	:	BUILDING G, SUITE 3
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4148
Country	:	US
Telephone Number	:	337-562-3732
Fax Number	:	337-562-3699

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	11/16/2012

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