Provider Demographics
NPI:1942695978
Name:ODERO CONSULTANTS
Entity Type:Organization
Organization Name:ODERO CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:O
Authorized Official - Last Name:ODERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-563-3998
Mailing Address - Street 1:7000 N 16TH ST
Mailing Address - Street 2:STE 120 # 199
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7000 N 16TH ST STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5524
Practice Address - Country:US
Practice Address - Phone:855-541-2862
Practice Address - Fax:405-716-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41308207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ438170Medicaid