Provider Demographics
NPI:1417300302
Name:ODLE, ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:ODLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N MOLTER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9811
Mailing Address - Country:US
Mailing Address - Phone:509-255-3785
Mailing Address - Fax:509-992-1572
Practice Address - Street 1:2110 N MOLTER RD STE 108
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-9811
Practice Address - Country:US
Practice Address - Phone:509-255-3785
Practice Address - Fax:509-992-1572
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60931347207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine