Provider Demographics
NPI:1619146321
Name:JEFFREY T OBRIEN MD INC
Entity Type:Organization
Organization Name:JEFFREY T OBRIEN MD INC
Other - Org Name:THE ORTHOPEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-394-2660
Mailing Address - Street 1:650 S COURTENAY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4977
Mailing Address - Country:US
Mailing Address - Phone:321-394-2660
Mailing Address - Fax:321-394-2669
Practice Address - Street 1:650 S COURTENAY PKWY
Practice Address - Street 2:STE 200A
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4977
Practice Address - Country:US
Practice Address - Phone:321-394-2660
Practice Address - Fax:321-394-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5251610001Medicare NSC