Active NPI
Duane I Odland, DO
- Family Medicine Physician
- Wasilla, AK
National Provider Identifier
1245388099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- AA1574
- Practice address
- 950 East Bogard
Suite 234
Wasilla, AK 99654 - Phone
- (907) 373-0850
- Fax
- (907) 373-0117
- NPI assigned
- Jan 8, 2007
- Last updated
- Mar 26, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | AA1574 | AK | Primary |
Addresses
Primary practice location
950 East Bogard
Suite 234
Wasilla, AK 99654
Mailing address
PO Box 876364
Wasilla, AK 99687
Phone (907) 373-2909
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD1574 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AA1574 | AK | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269561600000",
"number": "1245388099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 876364",
"city": "WASILLA",
"state": "AK",
"postal_code": "99687",
"telephone_number": "907-373-2909",
"fax_number": "907-373-0117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 EAST BOGARD",
"address_2": "SUITE 234",
"city": "WASILLA",
"state": "AK",
"postal_code": "99654",
"telephone_number": "907-373-0850",
"fax_number": "907-373-0117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODLAND",
"first_name": "DUANE",
"middle_name": "I",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2010-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AK",
"license": "AA1574",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MD1574",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.