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General NPI Number Information
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NPI Number | 1790012383
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Entity Type | Organization
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Legal Business Name | BRIAN E O'BYRNE, M.D. P.A.
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 2860 CHANNING WAY STE 117
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7532
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Country | US
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Telephone | 208-535-4470
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Fax | 208-535-4476
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Provider Business Mailing Address
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Address Line | 2860 CHANNING WAY STE 117
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7532
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Country | US
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Telephone | 208-535-4470
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Fax | 208-535-4476
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN E O'BYRNE
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Credential | M.D.
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Telephone | 208-535-4470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M6123
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License Number State | ID
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