Provider Demographics
NPI:1295823185
Name:ODOM, LORRIE F (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRIE
Middle Name:F
Last Name:ODOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:720 S COLORADO BLVD
Mailing Address - Street 2:SUITE 220A
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1912
Mailing Address - Country:US
Mailing Address - Phone:303-584-8231
Mailing Address - Fax:866-210-0907
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 6600
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1292
Practice Address - Country:US
Practice Address - Phone:303-832-2344
Practice Address - Fax:303-832-3721
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO19123207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59931744OtherMEDICAID GROUP NUMBER
COC809609OtherMEDICARE GROUP NUMBER
CO01191238Medicaid
CO88150062OtherMEDICAID PRACTICE GROUP #