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General NPI Number Information
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NPI Number | 1588615124
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Entity Type | Individual
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Provider Name | KEVIN BRUCE O'DELL MD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 566 RUIN CREEK RD
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City | HENDERSON
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State | NC
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Zip | 27536-2927
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Country | US
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Telephone | 252-436-1164
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Fax | 252-433-0280
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Provider Business Mailing Address
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Address Line | 1200 STILL FOREST CT
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City | GASTONIA
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State | NC
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Zip | 28056-6607
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Country | US
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Telephone | 704-473-3507
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 000039312
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 39312
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License Number State | NC
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