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General NPI Number Information
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NPI Number | 1083639397
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Entity Type | Individual
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Provider Name | PATRICK J O'BRIEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 8161 33RD AVE S UNIT 1702W
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4551
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Country | US
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Telephone | 952-303-2452
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Fax |
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Provider Business Mailing Address
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Address Line | 8161 33RD AVE S UNIT 1702W
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4551
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Country | US
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Telephone | 952-303-2452
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 32417
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License Number State | MN
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