Healthcare Provider Details

I. General information

NPI: 1932152667
Provider Name (Legal Business Name): ADRIAN B OBUCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/11/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 EAST EDISON AVE
SUNNYSIDE WA
98944
US

IV. Provider business mailing address

PO BOX 719
SUNNYSIDE WA
98944-0719
US

V. Phone/Fax

Practice location:
  • Phone: 509-712-3295
  • Fax:
Mailing address:
  • Phone: 509-837-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2015-0936
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA63718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: