Individual
DR. ODIE L BRACY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
6555 CARROLLTON AVE, INDIANAPOLIS, IN 46220-1664
(317) 257-9672
(317) 257-9674
Mailing address
6555 CARROLLTON AVE, INDIANAPOLIS, IN 46220-1664
(317) 257-9672
(317) 257-9674
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
20010368A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000085922
ANTHEM BC/BS
IN
05
—
100073260
—
IN
Enumeration date
06/15/2005
Last updated
12/29/2010
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