Healthcare Provider Details

I. General information

NPI: 1992761019
Provider Name (Legal Business Name): KEVIN MARK OBRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 BROOKWOOD MEDICAL CENTER DR STE 210
BIRMINGHAM AL
35209
US

IV. Provider business mailing address

2022 BROOKWOOD MEDICAL CENTER DR STE 210
BIRMINGHAM AL
35209
US

V. Phone/Fax

Practice location:
  • Phone: 205-879-2160
  • Fax: 205-879-2147
Mailing address:
  • Phone: 205-879-2160
  • Fax: 205-879-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number15880
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: