Provider Demographics
NPI:1245330745
Name:ODU, JUSTICE U (MD)
Entity type:Individual
Prefix:
First Name:JUSTICE
Middle Name:U
Last Name:ODU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:12221 MERIT DRIVE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251
Mailing Address - Country:US
Mailing Address - Phone:214-217-1900
Mailing Address - Fax:210-344-2649
Practice Address - Street 1:12221 MERIT DR.
Practice Address - Street 2:SUITE 1500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251
Practice Address - Country:US
Practice Address - Phone:214-217-1900
Practice Address - Fax:210-344-2649
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM5417207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J5672Medicare PIN