Provider Demographics
NPI:1003980749
Name:OBRIEN, NOEL STEPHEN (DPM)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:STEPHEN
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3801 SACRAMENTO STREET
Mailing Address - Street 2:SUITE 621
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1625
Mailing Address - Country:US
Mailing Address - Phone:415-600-4000
Mailing Address - Fax:415-600-4005
Practice Address - Street 1:3801 SACRAMENTO STREET
Practice Address - Street 2:SUITE 621
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1625
Practice Address - Country:US
Practice Address - Phone:415-600-4000
Practice Address - Fax:415-600-4005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE1228213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T10841Medicare UPIN