Provider Demographics
NPI:1780610717
Name:OBRIEN, KEVIN LEE (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:OBRIEN
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:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-692-4777
Mailing Address - Fax:405-692-4778
Practice Address - Street 1:809 N FINDLAY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6412
Practice Address - Country:US
Practice Address - Phone:405-310-4300
Practice Address - Fax:405-310-4311
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100256060Medicaid
OK100256060Medicaid