Healthcare Provider Details

I. General information

NPI: 1891121273
Provider Name (Legal Business Name): MARTIN OBRIEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7827 S FOREST ST
CENTENNIAL CO
80122-3821
US

IV. Provider business mailing address

7827 S FOREST ST
CENTENNIAL CO
80122-3821
US

V. Phone/Fax

Practice location:
  • Phone: 303-773-2394
  • Fax:
Mailing address:
  • Phone: 303-773-2394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number20251
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: