Provider Demographics
NPI:1134173016
Name:O'BRIEN, COLIN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:JAMES
Last Name:O'BRIEN
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 1:2771 OAKDALE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9747
Mailing Address - Country:US
Mailing Address - Phone:319-545-7310
Mailing Address - Fax:319-626-7314
Practice Address - Street 1:2769 HEARTLAND DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2732
Practice Address - Country:US
Practice Address - Phone:319-545-7310
Practice Address - Fax:319-545-7314
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA359802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19323OtherBLUE CROSS BLUE SHIELD
IA13568OtherBLUE CROSS BLUE SHIELD
IA13572OtherBLUE CROSS BLUE SHIELD
IA1486803Medicaid
IA0486803Medicaid
IA0486803Medicaid