Individual
DEBRA SUE ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1717A S UTICA AVE, TULSA, OK 74104
(918) 748-1300
(918) 748-1303
Mailing address
1717A S UTICA AVE, TULSA, OK 74104
(918) 748-1300
(918) 748-1303
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1340
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200023180A
—
OK
Enumeration date
05/02/2006
Last updated
01/08/2014
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