Provider Demographics
NPI:1013957026
Name:ODELL, ROBERT H JR (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:ODELL
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 W SAHARA
Mailing Address - Street 2:660
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5816
Mailing Address - Country:US
Mailing Address - Phone:702-257-7246
Mailing Address - Fax:702-586-2071
Practice Address - Street 1:8084 W SAHARA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1977
Practice Address - Country:US
Practice Address - Phone:702-247-7246
Practice Address - Fax:702-586-2071
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5774207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ955205Medicaid
TN15255131Medicaid
CO66485835Medicaid
NV1013957026Medicaid
UT1770556037Medicaid
NVEM534XMedicare PIN
NV1013957026Medicaid
UT1770556037Medicaid