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General NPI Number Information
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NPI Number | 1831276427
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Entity Type | Individual
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Provider Name | ELIZABETH SUSAN O BRIEN MD
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16216 BAXTER RD SUITE 299
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 636-530-9999
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Fax | 636-530-0977
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Provider Business Mailing Address
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Address Line | 12768 WHISPERING HILLS LANE
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City | ST LOUIS
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State | MO
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Zip | 63146
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Country | US
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Telephone | 314-469-4955
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R9J85
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License Number State | MO
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