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General NPI Number Information
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NPI Number | 1295938322
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Entity Type | Individual
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Provider Name | TIMOTHY STANLEY O'BRIEN PEDORTHIST
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 2641 SE OCEAN BLVD
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City | STUART
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State | FL
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Zip | 34996-3401
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Country | US
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Telephone | 772-283-3833
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Fax | 772-283-5632
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Provider Business Mailing Address
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Address Line | 245 S US HIGHWAY 1
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City | TEQUESTA
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State | FL
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Zip | 33469-2701
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Country | US
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Telephone | 561-746-3536
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Fax | 561-144-7851
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PED73
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License Number State | FL
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