Healthcare Provider Details

I. General information

NPI: 1740284553
Provider Name (Legal Business Name): JAMES OBRIEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10216 TAYLORSVILLE RD STE 400
LOUISVILLE KY
40299-3616
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-267-5456
  • Fax: 502-267-5488
Mailing address:
  • Phone: 502-489-5730
  • Fax: 502-489-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18973
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: