Individual
KEVIN BRUCE O'DELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
566 RUIN CREEK RD, HENDERSON, NC 27536-2927
(252) 436-1164
(252) 433-0280
Mailing address
1200 STILL FOREST CT, GASTONIA, NC 28056-6607
(704) 473-3507
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
000039312
NC
207P00000X
Emergency Medicine Physician
Primary
39312
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
63666
BSNC
NC
05
—
8963666
—
NC
Enumeration date
05/16/2006
Last updated
10/03/2023
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