Provider Demographics
NPI:1194042069
Name:ODOM, LYNDA GAYLE (MD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:GAYLE
Last Name:ODOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N AVENUE F
Mailing Address - Street 2:
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-2741
Mailing Address - Country:US
Mailing Address - Phone:806-592-9501
Mailing Address - Fax:806-592-3052
Practice Address - Street 1:415 N AVENUE F
Practice Address - Street 2:WEST TEXAS MEDICAL CENTER
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-2741
Practice Address - Country:US
Practice Address - Phone:806-592-9501
Practice Address - Fax:806-592-3052
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine