Provider Demographics
NPI:1477556322
Name:GOSSETT, ODIS WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ODIS
Middle Name:WAYNE
Last Name:GOSSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1039 N TWIN CITY HWY STE B
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-3851
Mailing Address - Country:US
Mailing Address - Phone:409-722-0026
Mailing Address - Fax:409-729-2783
Practice Address - Street 1:1039 N TWIN CITY HWY STE B
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-3851
Practice Address - Country:US
Practice Address - Phone:409-722-0026
Practice Address - Fax:409-729-2783
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H3101OtherBLUE CROSS
TX2358921OtherAETNA
TXP00004526OtherMEDICARE RAILROAD
TX04443OtherCIGNA
TX1327140-07Medicaid
TXG33702Medicare UPIN
TX04443OtherCIGNA