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General NPI Number Information
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NPI Number | 1558517102
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Entity Type | Organization
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Legal Business Name | MICHAEL OBRIEN MD PA
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 901 N CURTIS RD SUITE 101
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City | BOISE
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State | ID
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Zip | 83706-1338
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Country | US
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Telephone | 208-367-2802
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Fax | 208-375-8755
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Provider Business Mailing Address
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Address Line | 901 N CURTIS RD SUITE 101
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City | BOISE
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State | ID
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Zip | 83706-1338
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Country | US
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Telephone | 208-367-2802
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Fax | 208-375-8755
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | JEREMY EVANS
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Credential |
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Telephone | 208-367-2802
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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 | M2977
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License Number State | ID
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