Odom, Carl Irwin

Odom, Carl Irwin is an sole proprietor health care provider with primary practice located at 620 W Hays St , Boise ID 83702-5511. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Odom, Carl Irwin can be contacted via phone (208) 381-2094.

Contact Information

Primary practice address
620 W Hays St Boise ID 83702-5511
Phone: (208) 381-2094
Fax: (208) 381-1791
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X T0301 Texas
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X

Profile Details

NPI number 1740523513
LBN Legal business name Odom, Carl Irwin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 31st, 2013
Last updated Sep 12th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740523513 NPPES
Texas MEDICAID 371653203

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