Provider Demographics
NPI:1114017068
Name:O'DONNELL, BRENDAN RHODES
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:RHODES
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21616 76TH W AVE 209
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7512
Mailing Address - Country:US
Mailing Address - Phone:425-774-5163
Mailing Address - Fax:425-744-1705
Practice Address - Street 1:21616 76TH W AVE, SUITE 209
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7512
Practice Address - Country:US
Practice Address - Phone:425-774-5163
Practice Address - Fax:425-744-1705
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043309207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0231666OtherL&I
WA1114017068Medicaid
319820OtherINTERNAL ID-MOTOR VEHICLE ID
WA8855774Medicare PIN
I01755Medicare UPIN