Healthcare Provider Details

I. General information

NPI: 1639360944
Provider Name (Legal Business Name): GEORGE M OBRIEN DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 E UNIVERSITY DR #6
MESA AZ
85203-8237
US

IV. Provider business mailing address

1840 E UNIVERSITY DR #6
MESA AZ
85203-8237
US

V. Phone/Fax

Practice location:
  • Phone: 480-268-2670
  • Fax: 480-268-2671
Mailing address:
  • Phone: 480-268-2670
  • Fax: 480-268-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberE25929
License Number StateAZ

VIII. Authorized Official

Name: DR. GEORGE MATHEW O'BRIEN
Title or Position: PHYSICIAN
Credential: DO
Phone: 480-229-2714