Healthcare Provider Details

I. General information

NPI: 1700409828
Provider Name (Legal Business Name): DEMI LOUISE O'BRIEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE GATEWAY DR STE 148
GRIMES IA
50111-1307
US

IV. Provider business mailing address

7147 VISTA DR STE 150
WEST DES MOINES IA
50266-9317
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-9607
  • Fax:
Mailing address:
  • Phone: 515-875-9925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-50804
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: