Healthcare Provider Details

I. General information

NPI: 1134473192
Provider Name (Legal Business Name): JAMES JOSEPH O'BRYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10815 W 104TH ST
OVERLAND PARK KS
66214-3052
US

IV. Provider business mailing address

10815 W 104TH ST
OVERLAND PARK KS
66214-3052
US

V. Phone/Fax

Practice location:
  • Phone: 913-894-1443
  • Fax:
Mailing address:
  • Phone: 913-894-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-16522
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: