Odom, Wallace Paul

Odom, Wallace Paul is an individual health care provider with primary practice located at 911 Big Cove Rd Se , Huntsville AL 35801-3750. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Odom, Wallace Paul can be contacted via phone (256) 265-8120.

Contact Information

Primary practice address
911 Big Cove Rd Se Huntsville AL 35801-3750
Phone: (256) 265-8120
Fax: (256) 265-8969
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 1-071049 Alabama

Profile Details

NPI number 1508830308
LBN Legal business name Odom, Wallace Paul
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 16th, 2006
Last updated Dec 4th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508830308 NPPES
Alabama MEDICAID 051526353
Alabama Other 51526353
Alabama Other P00216451

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