# DR. BRIAN T ODONOGHUE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1962402842
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 32124 | KY | Yes |

## Other

- **Enumeration date:** 07/21/2005
- **Last updated:** 01/28/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000066552 | ANTHEM | KY |
| 01 | — | 1072079 | PASSPORT | KY |
| 05 | — | 65900656 | — | KY |