Healthcare Provider Details

I. General information

NPI: 1508187709
Provider Name (Legal Business Name): KEVIN T O'BRIEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 W COLONIAL DR SUITE 102
OCOEE FL
34761-4211
US

IV. Provider business mailing address

10125 W COLONIAL DR SUITE 102
OCOEE FL
34761-4211
US

V. Phone/Fax

Practice location:
  • Phone: 407-290-9355
  • Fax: 407-295-0033
Mailing address:
  • Phone: 407-290-9355
  • Fax: 407-295-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS 11916
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: