Provider Demographics
NPI:1114141223
Name:CHERIE H. O'BRIEN, M.D., P.A.
Entity Type:Organization
Organization Name:CHERIE H. O'BRIEN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-329-4433
Mailing Address - Street 1:1600 W COLLEGE ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:817-329-4433
Mailing Address - Fax:817-329-0190
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 410
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-329-4433
Practice Address - Fax:817-329-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE66278Medicare UPIN
TX00208VMedicare PIN