Healthcare Provider Details

I. General information

NPI: 1770232076
Provider Name (Legal Business Name): COLLIN J OBRYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 10TH ST SE STE 270
CEDAR RAPIDS IA
52403-2420
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 319-294-4319
  • Fax: 319-294-4298
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD-55963
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: