Provider Demographics
NPI:1124167259
Name:O'BRIEN, SHANNON BRIDGET (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:BRIDGET
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1462
Mailing Address - Fax:360-729-3104
Practice Address - Street 1:3100 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5746
Practice Address - Country:US
Practice Address - Phone:404-321-9900
Practice Address - Fax:907-228-8323
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK105120207X00000X
GA73558207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L4727Medicare PIN