Provider Demographics
NPI:1841361672
Name:ISSIS, JOHN ODEH (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ODEH
Last Name:ISSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:975 9TH AVE SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-4527
Mailing Address - Country:US
Mailing Address - Phone:205-481-7485
Mailing Address - Fax:205-481-7494
Practice Address - Street 1:975 9TH AVE SW
Practice Address - Street 2:SUITE 200
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4527
Practice Address - Country:US
Practice Address - Phone:205-481-7485
Practice Address - Fax:205-481-7494
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL13626208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00030139Medicaid
AL020045510OtherRAILROAD MEDICARE
AL00030139Medicaid
ALC70777Medicare UPIN