Provider Demographics
NPI:1326141854
Name:ODONNELL, WILLIAM CHARLES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:ODONNELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:708 HILL COUNTRY DR
Mailing Address - Street 2:BUILDING 300A
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6070
Mailing Address - Country:US
Mailing Address - Phone:830-257-5665
Mailing Address - Fax:830-896-4434
Practice Address - Street 1:708 HILL COUNTRY DR
Practice Address - Street 2:BUILDING 300A
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6070
Practice Address - Country:US
Practice Address - Phone:830-257-5665
Practice Address - Fax:830-896-4434
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE3389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A007OtherTRICARE
8AJ529OtherBLUE CROSS BLUE SHIELD
080111585OtherRAILROAD MEDICARE
5575460001OtherPALMETTO
TX115817204Medicaid
8AJ529OtherBLUE CROSS BLUE SHIELD
TX115817204Medicaid
8D1024Medicare PIN