Healthcare Provider Details

I. General information

NPI: 1336233972
Provider Name (Legal Business Name): BENJAMIN OBRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE ROAD TRIPLER ARMY MEDICAL CENTER
HONOLULU HI
96859-5000
US

IV. Provider business mailing address

91-229 MAKAHOU PL
KAPOLEI HI
96707-1943
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8199
  • Fax: 808-433-8334
Mailing address:
  • Phone: 808-888-4877
  • Fax: 808-888-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number53586311205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12738
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: