Individual
CARL IRWIN ODOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 W HAYS ST, BOISE, ID 83702-5511
(208) 381-2094
(208) 381-1791
Mailing address
12554 RIATA VISTA CIR, AUSTIN, TX 78727-6431
(512) 795-5100
(512) 795-5122
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
T0301
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371653203
—
TX
Enumeration date
03/31/2013
Last updated
09/12/2023
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