Provider Demographics
NPI:1942308184
Name:O'BRIEN, COLLEEN F (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:F
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10044 JUDY DR
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1463
Mailing Address - Country:US
Mailing Address - Phone:504-737-0411
Mailing Address - Fax:
Practice Address - Street 1:609 E GIBSON ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2980
Practice Address - Country:US
Practice Address - Phone:985-809-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA052926208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1576263Medicaid
LAH62061Medicare UPIN
LA1576263Medicaid