Basic Information
| Provider Information | |||||||||
| NPI: | 1437211794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 CLARKSON RD | ||||||||
| Address2: | |||||||||
| City: | ELLISVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630112278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362305050 | ||||||||
| FaxNumber: | 6362305057 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 CLARKSON RD | ||||||||
| Address2: | |||||||||
| City: | ELLISVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630112278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366857715 | ||||||||
| FaxNumber: | 3145905916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 07/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 2003000621 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000014182 | 01 | MO | ESSENCE | OTHER | 182228 | 01 | MO | BCBS | OTHER | 633328 | 01 | HEALTHLINK | OTHER | 322212 | 01 | GHP | OTHER | 7432465 | 01 | AETNA | OTHER | 00000001482 | 01 | ESSENCE | OTHER | 209258102 | 05 | MO | MEDICAID | 2312375 | 01 | UHC | OTHER | 036117870 | 01 | IL | BCBS IL | OTHER | 8008001 | 01 | CIGNA | OTHER |