Provider Demographics
NPI:1649272063
Name:OBRIEN, KURT B (MD)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:B
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:602 N LEWIS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2093
Mailing Address - Country:US
Mailing Address - Phone:337-364-7226
Mailing Address - Fax:337-364-7238
Practice Address - Street 1:602 N LEWIS ST
Practice Address - Street 2:STE 100
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2093
Practice Address - Country:US
Practice Address - Phone:337-364-7226
Practice Address - Fax:337-364-7238
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA12-927R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1554821Medicaid
G95315Medicare UPIN
LA1554821Medicaid