Individual
CHARLES A ODOM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
10700 MCPHERSON AVE, LAREDO, TX 78045-6268
(956) 523-2619
Mailing address
8511 MCPHERSON ROAD, SUITE 105, PMB 233, LAREDO, TX 78045
(956) 523-2619
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
221707
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84078U
BCBS
TX
01
—
P00129710
MEDICARE RAILROAD
TX
Enumeration date
01/30/2006
Last updated
07/08/2007
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