Provider Demographics
NPI:1104191667
Name:JOHN C. O'BRIEN, JR., MD, PA
Entity Type:Organization
Organization Name:JOHN C. O'BRIEN, JR., MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-320-9163
Mailing Address - Street 1:8223 FOREST HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4410
Mailing Address - Country:US
Mailing Address - Phone:214-320-9163
Mailing Address - Fax:214-320-9163
Practice Address - Street 1:8223 FOREST HILLS BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4410
Practice Address - Country:US
Practice Address - Phone:214-320-9163
Practice Address - Fax:214-320-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD 68352086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1134298-02Medicaid
TXC19972Medicare UPIN