Individual
DR. AUDREY R ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 CHILDRENS PL STE C, STE C, SAINT LOUIS, MO 63110-1002
(314) 454-6050
(314) 454-2836
Mailing address
1 CHILDRENS PL, CB 8116, SAINT LOUIS, MO 63110-1002
(314) 454-6050
(314) 454-2836
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2008022993
MO
2080P0208X
Pediatric Infectious Diseases Physician
Primary
2008022993
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215949276
—
MO
05
—
ENROLLED
—
IL
Enumeration date
08/11/2006
Last updated
01/24/2018
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