Individual
DR. AUDREY RAGAN ODOM JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD PHD
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(314) 616-5691
Mailing address
734 SCHUYLKILL AVE, PHILADELPHIA, PA 19146-2300
(314) 616-5691
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2008022993
MO
208000000X
Pediatrics Physician
MD468283
PA
2080P0208X
Pediatric Infectious Diseases Physician
Primary
2008022993
MO
2080P0208X
Pediatric Infectious Diseases Physician
Primary
MD468283
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215949276
—
MO
05
—
ENROLLED
—
IL
Enumeration date
08/11/2006
Last updated
07/10/2026
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