Healthcare Provider Details

I. General information

NPI: 1699860296
Provider Name (Legal Business Name): MARY CHRISTINE OBRIEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GREELEY CBOC 2020 16TH ST,SUITE1
GREELEY CO
80634
US

IV. Provider business mailing address

2509 RESEARCH BLVD
FORT COLLINS CO
80526-8108
US

V. Phone/Fax

Practice location:
  • Phone: 970-313-0027
  • Fax: 970-313-2124
Mailing address:
  • Phone: 970-244-1550
  • Fax: 970-407-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44514
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: