Healthcare Provider Details

I. General information

NPI: 1942308184
Provider Name (Legal Business Name): COLLEEN F. O'BRIEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E GIBSON ST
COVINGTON LA
70433-2980
US

IV. Provider business mailing address

10044 JUDY DR
RIVER RIDGE LA
70123-1463
US

V. Phone/Fax

Practice location:
  • Phone: 985-809-3860
  • Fax:
Mailing address:
  • Phone: 504-737-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number052926
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: