Healthcare Provider Details

I. General information

NPI: 1790365690
Provider Name (Legal Business Name): COLIN O'BRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 260
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

PO BOX 1600
VANCOUVER WA
98668-1600
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-6450
  • Fax: 360-514-6451
Mailing address:
  • Phone: 360-514-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61577339
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: