Provider Demographics
NPI:1083634349
Name:ODELL, STEVEN F (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:F
Last Name:ODELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 ORCHARD AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2997
Mailing Address - Country:US
Mailing Address - Phone:970-243-9340
Mailing Address - Fax:970-241-6894
Practice Address - Street 1:1060 ORCHARD AVE
Practice Address - Street 2:SUITE I
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2997
Practice Address - Country:US
Practice Address - Phone:970-243-9340
Practice Address - Fax:970-241-6894
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27609208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01276096Medicaid
36539OtherBCBS
CO01276096Medicaid
COC7672Medicare PIN