Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 00669 | NC |
Y | 2081P2900X | Pain Medicine | 200001225 | NC |
N | 2081P2900X | Pain Medicine | 27854 | SC |
NPI | 1063479327 |
---|---|
Provider Name | Dr. David Reese O'brien JR. |
First Address | Winston Salem, NC 27157-0001 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0908591 | UHC PROVIDER # (01) | NC |
127R9 | BCBS PROVIDER # (01) | NC |
250012093 | RR MEDICARE PROVIDER # (01) | NC |
38684 | BLUE MEDICARE PROVIDER # (01) | NC |
A1174 | MEDCOST PROVIDER # (01) | NC |
G14186 | (02) | NC |