Provider Demographics
NPI:1346275146
Name:ODOM, FLOYD C (MD)
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:C
Last Name:ODOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:16980 DALLAS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1974
Mailing Address - Country:US
Mailing Address - Phone:214-343-8565
Mailing Address - Fax:214-343-3689
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:SUITE 205
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-739-5758
Practice Address - Fax:214-739-0016
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD9596208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098170603Medicaid
TX098170601Medicaid