Healthcare Provider Details

I. General information

NPI: 1366611261
Provider Name (Legal Business Name): DAVID MELTON O'DELL M.D., J.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 HIGHWAY 377 S
BROWNWOOD TX
76801-5120
US

IV. Provider business mailing address

1100 W REYNOSA AVE
DE LEON TX
76444-1630
US

V. Phone/Fax

Practice location:
  • Phone: 325-643-5167
  • Fax: 325-641-1856
Mailing address:
  • Phone: 254-893-5895
  • Fax: 254-893-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE1093
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE1093
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: