| Doctor Name: | STACEY J ODDMAN |
| NPI Number: | 1003921222 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | ME87585 |
| Business Practice Address: | 4004 N Ocean Blvd Ft Lauderdale, FL - 333086420 |
| Business Phone Number: | 9545641330 |
| Business Fax Number: | 9545640538 |
| Mailing Address: | 4004 N Ocean Blvd, FT LAUDERDALE |
| State: | FL |
| Postal Code: | 333086420 |
| Phone Number: | 9545641330 |
| Fax Number: | 9545640538 |
| NPI Enumeration Date: | 08/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | ME87585 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |