Basic Information
Provider Information | |||||||||
NPI: | 1487823233 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | JEFFREY T OBRIEN MD INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | THE ORTHOPEDIC CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 650 S COURTENAY PKWY | ||||||||
Address2: | SUITE 200 | ||||||||
City: | MERRITT ISLAND | ||||||||
State: | FL | ||||||||
PostalCode: | 329524977 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3213942660 | ||||||||
FaxNumber: | 3213942669 | ||||||||
Practice Location | |||||||||
Address1: | 1421 MALABAR RD NE OFC BUILDING | ||||||||
Address2: | STE 200 | ||||||||
City: | PALM BAY | ||||||||
State: | FL | ||||||||
PostalCode: | 329072576 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3213082660 | ||||||||
FaxNumber: | 3219849303 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/26/2008 | ||||||||
LastUpdateDate: | 08/07/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | O'BRIEN | ||||||||
AuthorizedOfficialFirstName: | JEFFREY | ||||||||
AuthorizedOfficialMiddleName: | T | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 3213942660 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   | FL | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
No ID Information.