Provider Demographics
NPI:1356309207
Name:O'BEIRNE, EDWARD NETTERVILLE IV (PA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:NETTERVILLE
Last Name:O'BEIRNE
Suffix:IV
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19655 N 34TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3931
Mailing Address - Country:US
Mailing Address - Phone:602-405-6672
Mailing Address - Fax:
Practice Address - Street 1:7400 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6432
Practice Address - Country:US
Practice Address - Phone:480-882-4000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1911363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical