Individual
DOUGLAS LAWRENCE O'DEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7378 YALE RD, BARTLETT, TN 38133-3604
(901) 387-0193
(901) 387-0796
Mailing address
PO BOX 902, DEPT 100, MEMPHIS, TN 38101-0902
(901) 757-2791
(901) 757-9065
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD0000018194
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0108564
BLUECROSS OF TENNESSEE
TN
05
—
3027190
—
TN
Enumeration date
06/27/2006
Last updated
10/31/2012
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