Provider Demographics
NPI:1790727840
Name:ODAL, MARCIA (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:ODAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 MT. VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549
Mailing Address - Country:US
Mailing Address - Phone:325-574-7230
Mailing Address - Fax:
Practice Address - Street 1:1700 COGDELL BLVD
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-6162
Practice Address - Country:US
Practice Address - Phone:325-573-6374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4334207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine