Provider Demographics
NPI:1508967878
Name:O'BRYAN, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:O'BRYAN
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 1:1401 CENTERVILLE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4647
Mailing Address - Country:US
Mailing Address - Phone:850-877-7241
Mailing Address - Fax:850-877-1338
Practice Address - Street 1:1401 CENTERVILLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4647
Practice Address - Country:US
Practice Address - Phone:850-877-7241
Practice Address - Fax:850-656-9473
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049732207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039241300Medicaid
FLD69027Medicare UPIN
FL039241300Medicaid