Provider Demographics
NPI:1972578870
Name:O'GRADY, BRIAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 S BREEZY WAY
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7443
Mailing Address - Country:US
Mailing Address - Phone:509-528-8880
Mailing Address - Fax:
Practice Address - Street 1:869 S BREEZY WAY
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7443
Practice Address - Country:US
Practice Address - Phone:509-528-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60056621207T00000X
TXJ5428207T00000X
IDM14355207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0244859OtherLABOR & INDUSTRIES
TX1275570-04Medicaid
WA8533796Medicaid
TXE63904Medicare UPIN
WA8533796Medicaid
WA0244859OtherLABOR & INDUSTRIES
WA8878512Medicare PIN