Provider Demographics
NPI:1710972575
Name:O'BRIEN, KELSEY H (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:H
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6301 GASTON AVE STE 125P
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6207
Mailing Address - Country:US
Mailing Address - Phone:214-912-1531
Mailing Address - Fax:469-757-4890
Practice Address - Street 1:6301 GASTON AVE STE 125P
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-6207
Practice Address - Country:US
Practice Address - Phone:214-912-1531
Practice Address - Fax:469-757-4890
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME137463208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLWV6QEOtherBLUE CROSS BLUE SHIELD
FL101612700Medicaid