Provider Demographics
NPI:1659444206
Name:OBRIEN, MARK STEPHEN (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11432 295TH ROAD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63565
Mailing Address - Country:US
Mailing Address - Phone:660-947-2138
Mailing Address - Fax:
Practice Address - Street 1:1001 E PENNSYLVALIA AVE
Practice Address - Street 2:OTTUMWA REGIONAL MEDICAL CENTER
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501
Practice Address - Country:US
Practice Address - Phone:641-684-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5C60207Q00000X
IA02335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G38728Medicare UPIN
D41493Medicare UPIN