MEDICARE: JOHN OBRIEN RVT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246XC2903X	Vascular Specialist/Technologist Cardiovascular	4363	WA

General Provider Information

NPI Number	:	1518074459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN OBRIEN RVT

Provider Business Mailing Address
First Line	:	3104 SQUALICUM PKWY
Second Line	:	SUITE 101
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1936
Country	:	US
Telephone Number	:	360-733-8128
Fax Number	:	360-733-5354

Provider Business Practice Location Address
First Line	:	3104 SQUALICUM PKWY
Second Line	:	SUITE 101
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1936
Country	:	US
Telephone Number	:	360-733-8128
Fax Number	:	360-733-5354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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Directions to “ JOHN OBRIEN RVT” Practice Location

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