Healthcare Provider Details

I. General information

NPI: 1780143024
Provider Name (Legal Business Name): JAMES ROBERT O'BRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

IV. Provider business mailing address

1800 HARRISON ST FL 7
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2000
  • Fax:
Mailing address:
  • Phone: 510-625-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125.073615
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036164831
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA195340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: