Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD203048 | LA |
NPI | 1104960657 |
---|---|
Provider Name | Dr. Michael J. O'brien |
First Address | New Orleans, LA 70112-2632 |
Second Address | New Orleans, LA 70112-2632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2007 |
Last Update Date | 08/08/2011 |