Individual
JACQUELINE S TAYLOR ODONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
(903) 614-3525
Mailing address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
(903) 614-3525
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
E2888
AR
207R00000X
Internal Medicine Physician
Primary
L3496
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0092MN
BCBS
TX
05
—
145436001
—
AR
05
—
145871301
—
TX
01
—
5M000
BCBS
AR
01
—
DD3261
RR MEDICARE
TX
Enumeration date
11/09/2005
Last updated
11/01/2011
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