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Individual

OMOROVBIYE T ODIGIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 894-0400
(508) 941-6200
Mailing address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 894-0400
(508) 941-6200

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2135
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2135
LICENSE
MA
01
51484
LICENSE
CA
Enumeration date
09/11/2007
Last updated
05/22/2015
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