Healthcare Provider Details

I. General information

NPI: 1912034802
Provider Name (Legal Business Name): DENNIS MATTHEW O'BRIEN C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 TAUB LOOP
HOUSTON TX
77030-1608
US

IV. Provider business mailing address

310 W 6TH ST
HOUSTON TX
77007-2405
US

V. Phone/Fax

Practice location:
  • Phone: 713-793-2860
  • Fax:
Mailing address:
  • Phone: 281-450-2953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number685285
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: