Healthcare Provider Details

I. General information

NPI: 1255445862
Provider Name (Legal Business Name): JOHN J OBRIEN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 38TH AVE N
ST PETERSBURG FL
33710-1134
US

IV. Provider business mailing address

7855 38TH AVE N
ST PETERSBURG FL
33710-1134
US

V. Phone/Fax

Practice location:
  • Phone: 727-341-2408
  • Fax: 727-341-2708
Mailing address:
  • Phone: 727-341-2408
  • Fax: 727-341-2708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberME0066063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: