Provider Demographics
NPI:1639360944
Name:GEORGE M OBRIEN DO PLLC
Entity Type:Organization
Organization Name:GEORGE M OBRIEN DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-229-2714
Mailing Address - Street 1:1840 E UNIVERSITY DR
Mailing Address - Street 2:#6
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8237
Mailing Address - Country:US
Mailing Address - Phone:480-268-2670
Mailing Address - Fax:480-268-2671
Practice Address - Street 1:1840 E UNIVERSITY DR
Practice Address - Street 2:#6
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8237
Practice Address - Country:US
Practice Address - Phone:480-268-2670
Practice Address - Fax:480-268-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZE25929207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101643Medicare PIN