Healthcare Provider Details

I. General information

NPI: 1578509691
Provider Name (Legal Business Name): JOHN O'BRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 S TAMIAMI TRL
SARASOTA FL
34231-4029
US

IV. Provider business mailing address

1045 SCHERER WAY
OSPREY FL
34229-6870
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-5678
  • Fax:
Mailing address:
  • Phone: 941-918-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME 92770
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME92770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: