Provider Demographics
NPI:1215999875
Name:ODELL, RICHARD H (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:ODELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1474
Mailing Address - Country:US
Mailing Address - Phone:801-272-4219
Mailing Address - Fax:801-274-8565
Practice Address - Street 1:1345 E 3900 S STE 110
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4403
Practice Address - Country:US
Practice Address - Phone:801-272-4219
Practice Address - Fax:801-274-8565
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT207N00000X207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology