Provider Demographics
NPI:1104125418
Name:O'BRIEN, DAVID RAYMOND (MD, MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAYMOND
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 W SUMMIT PKWY APT 306
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3133
Mailing Address - Country:US
Mailing Address - Phone:707-273-2246
Mailing Address - Fax:
Practice Address - Street 1:1907 W SUMMIT PKWY APT 306
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3133
Practice Address - Country:US
Practice Address - Phone:707-273-2246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine