Provider Demographics
NPI:1124230990
Name:OBRIEN, PATRICK JOHN (AUD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOHN
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 SW INDIAN KEY DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2053
Mailing Address - Country:US
Mailing Address - Phone:772-240-5429
Mailing Address - Fax:
Practice Address - Street 1:567 SW INDIAN KEY DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2053
Practice Address - Country:US
Practice Address - Phone:772-240-5429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY1054Medicare UPIN