Provider Demographics
NPI:1568739050
Name:O'BRIEN, BRENDA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ELIZABETH
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 LILLEHAMMER LN
Mailing Address - Street 2:UNIT 4205
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-6052
Mailing Address - Country:US
Mailing Address - Phone:435-645-8379
Mailing Address - Fax:435-604-7819
Practice Address - Street 1:5501 LILLEHAMMER LN
Practice Address - Street 2:UNIT 4205
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6052
Practice Address - Country:US
Practice Address - Phone:435-645-8379
Practice Address - Fax:435-604-7819
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT185826-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC59192Medicare UPIN
UTOB626727Medicare PIN