Individual
ROBERT F ODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
180 WINGO WAY, SUITE 306, MT PLEASANT, SC 29464-1810
(843) 884-1777
Mailing address
180 WINGO WAY, SUITE 306, MT PLEASANT, SC 29464-1810
(843) 884-1777
(843) 884-0710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
SC6115
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061159
—
SC
01
—
571020809012
BCBS OF SC
SC
01
—
571020809058
TRICARE
SC
Enumeration date
05/16/2006
Last updated
10/11/2007
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