Provider Demographics
NPI:1770641870
Name:OCONNOR, BRIAN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:P
Other - Last Name:OCONNOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:675 S ARROYO PKWY
Mailing Address - Street 2:STE 400
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3264
Mailing Address - Country:US
Mailing Address - Phone:626-795-4116
Mailing Address - Fax:626-568-3127
Practice Address - Street 1:675 S ARROYO PKWY
Practice Address - Street 2:STE 400
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3264
Practice Address - Country:US
Practice Address - Phone:626-795-4116
Practice Address - Fax:626-568-3127
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG040893207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G408930Medicaid
A48390Medicare UPIN
G40893Medicare PIN