Provider Demographics
NPI:1861486482
Name:ODERINDE, VICTOR A (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:A
Last Name:ODERINDE
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 1:17207 KUYKENDAHL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8423
Mailing Address - Country:US
Mailing Address - Phone:281-374-8555
Mailing Address - Fax:281-374-8335
Practice Address - Street 1:17207 KUYKENDAHL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8423
Practice Address - Country:US
Practice Address - Phone:281-374-8555
Practice Address - Fax:281-374-8335
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL11482084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K0020OtherBC/BS NUMBER
8A9847Medicare PIN
TXH64373Medicare UPIN