Provider Demographics
NPI:1679733695
Name:MEARS, ROY ODEM (DO)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:ODEM
Last Name:MEARS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1727
Mailing Address - Country:US
Mailing Address - Phone:970-241-7600
Mailing Address - Fax:970-644-3961
Practice Address - Street 1:743 HORIZON CT STE 100
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81506-8715
Practice Address - Country:US
Practice Address - Phone:970-241-7600
Practice Address - Fax:970-245-9094
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99830248Medicaid
CO50421OtherSTATE MEDICAL LICENSE