Individual
DAVID DEVAUL ODINEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7973 W DESTINY BLVD, FORT CAMPBELL, KY 42223-5429
(270) 798-4677
Mailing address
7973 W DESTINY BLVD, FORT CAMPBELL, KY 42223-5429
(270) 798-4677
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
65771
TN
208D00000X
General Practice Physician
7462220
WI
Other
Enumeration date
06/28/2017
Last updated
09/19/2022
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