Provider Demographics
NPI:1255445862
Name:OBRIEN, JOHN J JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:OBRIEN
Suffix:JR
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 1:7855 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1134
Mailing Address - Country:US
Mailing Address - Phone:727-341-2408
Mailing Address - Fax:727-341-2708
Practice Address - Street 1:7855 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1134
Practice Address - Country:US
Practice Address - Phone:727-341-2408
Practice Address - Fax:727-341-2708
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00660632082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
F52627Medicare UPIN
FL25235Medicare ID - Type Unspecified