Carl Theodore Opderbeck, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

196220 Issued in NY

Practice address

Route 7 and Route 12
Fort Defiance Indian Hospital
Fort Defiance, AZ 86504-0649

Phone

(928) 729-8020

Fax

(828) 729-8794

NPI assigned

Aug 26, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DHHS PHS Naihs Fort Defiance Hospital

  • General Acute Care Hospital
  • Fort Defiance, AZ
  • NPI 1700962131
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219708800000",
    "number": "1316194954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 LOG CABIN LN",
            "city": "UNION MILLS",
            "state": "NC",
            "postal_code": "281679004",
            "telephone_number": "828-288-0012",
            "fax_number": "828-288-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROUTE 7 AND ROUTE 12",
            "address_2": "FORT DEFIANCE INDIAN HOSPITAL",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865040649",
            "telephone_number": "928-729-8020",
            "fax_number": "828-729-8794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OPDERBECK",
        "first_name": "CARL",
        "middle_name": "THEODORE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-26",
        "last_updated": "2008-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "196220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Oduro, PHARMD
• Xin Ying Serena Oh, PHARMD
• Mutiu Oluseyi Okanlawon, R.PH
• Esther Okorie
• Chikanele Chidinma Onyegam, PHARMD
• Renee Ornelas, MD
• Beth Ann Ortiz
• Jose Alberto Ortiz
• Moses A. Owoso, MD
• Rachael Oyewole, PHARMD

• Obstetrics & Gynecology Physician in Fort Defiance, AZ
• Providers in Fort Defiance, AZ by specialty
• Obstetrics & Gynecology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.