Individual
FRED OCHIENG ODAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1021 MAJESTIC DR STE 200, LEXINGTON, KY 40513-1867
(859) 296-1922
(859) 224-8721
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7825
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
55211
KY
2084N0400X
Neurology Physician
R4566
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100543080
—
KY
Enumeration date
03/23/2017
Last updated
06/14/2021
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