Provider Demographics
NPI:1295938322
Name:O'BRIEN, TIMOTHY STANLEY (PEDORTHIST)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:STANLEY
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2701
Mailing Address - Country:US
Mailing Address - Phone:561-746-3536
Mailing Address - Fax:561-144-7851
Practice Address - Street 1:2641 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3401
Practice Address - Country:US
Practice Address - Phone:772-283-3833
Practice Address - Fax:772-283-5632
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED73174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5114170001Medicare NSC