Organization
CHARLES A ODOM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES A ODOM CRNA (OWNER)
(956) 725-4003
Entity
Organization
Contact information
Practice address
5313 MCPHERSON RD, LAREDO, TX 78041
(956) 725-4003
(956) 725-4220
Mailing address
5313 MCPHERSON RD, LAREDO, TX 78041
(956) 795-8310
(956) 795-8313
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
221707
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C85S
BCBS
TX
Enumeration date
09/21/2006
Last updated
08/22/2020
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