Individual
CHARLES ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1935 MEDICAL DISTRICT DR, DALLAS, TX 75235-7701
(214) 456-8899
(214) 456-5986
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 645-0624
(214) 645-0078
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
47282
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP10069154
MEDICAL LICENSE
TX
Enumeration date
04/28/2015
Last updated
07/26/2021
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