Healthcare Provider Details

I. General information

NPI: 1487627758
Provider Name (Legal Business Name): JEFFREY T OBRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S COURTENAY PKWY SUITE 200
MERRITT ISLAND FL
32952-4977
US

IV. Provider business mailing address

650 S COURTENAY PKWY SUITE 200
MERRITT ISLAND FL
32952-4977
US

V. Phone/Fax

Practice location:
  • Phone: 321-394-2660
  • Fax: 321-394-2669
Mailing address:
  • Phone: 321-394-2660
  • Fax: 321-394-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME70348
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: