Provider Demographics
NPI:1699284588
Name:O'DELL, DEREK JEFFERSON (DVM)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JEFFERSON
Last Name:O'DELL
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-1819
Mailing Address - Country:US
Mailing Address - Phone:540-342-7821
Mailing Address - Fax:
Practice Address - Street 1:1309 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-1819
Practice Address - Country:US
Practice Address - Phone:540-342-7821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVETERINARIAN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program