MEDICARE: DR. SEAN M. O'BRIEN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	2883	AZ
2	207R00000X	Internal Medicine Physician	2883	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912994500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN M. O'BRIEN D.O.

Provider Business Mailing Address
First Line	:	825 N GRAND AVE STE 100
Second Line	:
City	:	NOGALES
State	:	AZ
Zip	:	85621-1061
Country	:	US
Telephone Number	:	520-761-2133
Fax Number	:	520-281-1112

Provider Business Practice Location Address
First Line	:	3231 N GRAND AVE
Second Line	:
City	:	NOGALES
State	:	AZ
Zip	:	85621-3905
Country	:	US
Telephone Number	:	520-281-1550
Fax Number	:	520-281-1112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	01/17/2024

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