Provider Demographics
NPI:1124076757
Name:O'BRIEN, PATRICK WILLIAM (PA)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:WILLIAM
Last Name:O'BRIEN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:9225 N 3RD ST #307
Mailing Address - Street 2:EMCARE HONOR HEALTH JOHN C LINCOLN MEDICAL CENTER
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-430-3536
Mailing Address - Fax:602-870-6091
Practice Address - Street 1:9225 N 3RD ST STE 307
Practice Address - Street 2:EMCARE JOHN C LINCOLN MEDICAL CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2466
Practice Address - Country:US
Practice Address - Phone:602-870-6316
Practice Address - Fax:602-870-6091
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-01-12
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Provider Licenses
StateLicense IDTaxonomies
MO2010041704363A00000X
AZ1320363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1320OtherSTATE LICENSE NUMBER
AZS84486 67940Medicare UPIN