Basic Information
Provider Information
NPI: 1124076757
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: O'BRIEN
FirstName: PATRICK
MiddleName: WILLIAM
NamePrefix: MR.
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9225 N 3RD ST #307
Address2: EMCARE HONOR HEALTH JOHN C LINCOLN MEDICAL CENTER
City: PHOENIX
State: AZ
PostalCode: 85020
CountryCode: US
TelephoneNumber: 6024303536
FaxNumber: 6028706091
Practice Location
Address1: 9225 N 3RD ST STE 307
Address2: EMCARE JOHN C LINCOLN MEDICAL CENTER
City: PHOENIX
State: AZ
PostalCode: 850202466
CountryCode: US
TelephoneNumber: 6028706316
FaxNumber: 6028706091
Other Information
ProviderEnumerationDate: 05/05/2006
LastUpdateDate: 01/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X2010041704MON Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363AM0700X1320AZN Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
363AS0400X1320AZY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

ID Information
IDTypeStateIssuerDescription
132001AZSTATE LICENSE NUMBEROTHER


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