Individual
DR. THOMAS G. O'DANIEL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
222 S 1ST ST, SUITE 100, LOUISVILLE, KY 40202-1350
(502) 584-1109
(502) 589-6882
Mailing address
222 S 1ST ST, SUITE 100, LOUISVILLE, KY 40202-1350
(502) 584-1109
(502) 589-6882
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
24070
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000219660
ANTHEM PIN
KY
01
—
002
CIGNA
KY
05
—
100033340A
—
IN
01
—
1058697
PASSPORT PIN
KY
05
—
64240708
—
KY
01
—
667357
HEALTHLINK
KY
01
—
KY0057799
TRICARE
KY
01
—
KY1118
HEALTHNET PIN
KY
Enumeration date
08/15/2005
Last updated
04/04/2016
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