Provider Demographics
NPI:1285945402
Name:ODUM, BRIAN R (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:ODUM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:660 OFFICE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7103
Mailing Address - Country:US
Mailing Address - Phone:314-991-3556
Mailing Address - Fax:314-991-0691
Practice Address - Street 1:615 S. NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-6000
Practice Address - Fax:573-884-4612
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2017-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2014001410207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology