Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN 12535 | FL |
NPI | 1043327828 |
---|---|
Provider Name | Dr. David Allan O'brien |
First Address | Orange Park, FL 32073-5723 |
Second Address | Orange Park, FL 32073-5723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 07/04/2011 |