Provider Demographics
NPI:1407803331
Name:O'BRIEN, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:O'BRIEN
Suffix:
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 1:1201 S EUCLID AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-7700
Mailing Address - Country:US
Mailing Address - Phone:605-328-3840
Mailing Address - Fax:605-328-3841
Practice Address - Street 1:1201 S EUCLID AVE
Practice Address - Street 2:STE 104
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-7700
Practice Address - Country:US
Practice Address - Phone:605-328-3840
Practice Address - Fax:605-328-3841
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2030208600000X
MN22313208600000X
IA24561208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS41267Medicare PIN
SD020047753Medicare PIN
D28512Medicare UPIN