Provider Demographics
NPI:1063479327
Name:O'BRIEN, DAVID REESE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REESE
Last Name:O'BRIEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-3202
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC006692081P2900X
SC278542081P2900X
NC2000012252081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127R9OtherBCBS PROVIDER #
NC38684OtherBLUE MEDICARE PROVIDER #
NCA1174OtherMEDCOST PROVIDER #
NC0908591OtherUHC PROVIDER #
NC250012093OtherRR MEDICARE PROVIDER #
NC38684OtherBLUE MEDICARE PROVIDER #
NC250012093OtherRR MEDICARE PROVIDER #
NC89-127R9Medicare ID - Type Unspecified