Doctor Name: | DR. TAMANNA SHAMS O'DEA |
NPI Number: | 1669791018 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 01069916A |
Business Practice Address: | 222 Bergquist Drive Wilford Hall Medical Center Apo, AA - 782366432 |
Business Phone Number: | 2102927563 |
Business Fax Number: | |
Mailing Address: | 222 Bergquist Drive, Wilford Hall Medical Center APO |
State: | AA |
Postal Code: | 78236 |
Phone Number: | 2102927563 |
Fax Number: | |
NPI Enumeration Date: | 05/25/2010 |
NPI Last Update Date: | 09/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01069916A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |