Provider Demographics
NPI:1104825678
Name:O'DONNELL, BRIAN M (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 TREASURE HILLS BLVD STE 2D
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8913
Mailing Address - Country:US
Mailing Address - Phone:956-425-4982
Mailing Address - Fax:956-241-4051
Practice Address - Street 1:1713 TREASURE HILLS BLVD STE 2D
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8913
Practice Address - Country:US
Practice Address - Phone:956-425-4982
Practice Address - Fax:956-421-4051
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150751901Medicaid
TX150751901Medicaid
TXH58069Medicare UPIN