Provider Demographics
NPI:1134411192
Name:O'BRIEN, SEAN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
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 1:119 S THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:RUSHMORE
Mailing Address - State:MN
Mailing Address - Zip Code:56168-9674
Mailing Address - Country:US
Mailing Address - Phone:651-408-4980
Mailing Address - Fax:
Practice Address - Street 1:119 S THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:RUSHMORE
Practice Address - State:MN
Practice Address - Zip Code:56168-9674
Practice Address - Country:US
Practice Address - Phone:651-408-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59208208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics