Provider Demographics
NPI:1194899765
Name:ODDVAR A. MYHRE, M.D., INC.
Entity type:Organization
Organization Name:ODDVAR A. MYHRE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ODDVAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYHRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-963-5739
Mailing Address - Street 1:79146 CETRINO
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-6544
Mailing Address - Country:US
Mailing Address - Phone:310-963-5739
Mailing Address - Fax:310-545-8561
Practice Address - Street 1:79146 CETRINO
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-6544
Practice Address - Country:US
Practice Address - Phone:310-963-5739
Practice Address - Fax:310-545-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22327208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A223270Medicaid
CA00A223270OtherBLUE CROSS OF CA
CA00A223270OtherBLUE SHIELD OF CA
CA00A223270OtherBLUE CROSS OF CA
CAA23019Medicare UPIN