Provider Demographics
NPI:1205035086
Name:ODOM, DAVID MALCOLM (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MALCOLM
Last Name:ODOM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3001 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6982
Mailing Address - Country:US
Mailing Address - Phone:858-900-1288
Mailing Address - Fax:866-598-2420
Practice Address - Street 1:3001 E TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6982
Practice Address - Country:US
Practice Address - Phone:858-900-1288
Practice Address - Fax:866-598-2420
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2016-06-15
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Provider Licenses
StateLicense IDTaxonomies
AK1288207L00000X, 207RE0101X
CAC33440207L00000X, 207RE0101X, 2083P0901X, 2083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKA35279Medicare UPIN