Provider Demographics
NPI:1457606642
Name:ODEH, AMAN MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:AMAN
Middle Name:MOHAMMED
Last Name:ODEH
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 1:7105 RIDGE OAK RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1956
Mailing Address - Country:US
Mailing Address - Phone:937-856-1635
Mailing Address - Fax:
Practice Address - Street 1:7900 FARM TO MARKET RD 1826
Practice Address - Street 2:SETON SOUTHWEST,
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737
Practice Address - Country:US
Practice Address - Phone:512-324-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6970208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program