Healthcare Provider Details

I. General information

NPI: 1194726992
Provider Name (Legal Business Name): WILLIAM M OBRYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BRECKENRIDGE ST SUITE 300
OWENSBORO KY
42303-0839
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-685-7150
  • Fax: 270-685-7173
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20619
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: