Provider Demographics
NPI:1215944772
Name:O'BRIEN, MARCUS D (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:D
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-2963
Practice Address - Street 1:1 CHILDRENS WAY #653
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202
Practice Address - Country:US
Practice Address - Phone:501-364-1100
Practice Address - Fax:501-364-2963
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6643208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113022001Medicaid
13317000000OtherQUALCHOICE
AR51068OtherBLUECROSS BLUESHIELD
AR536103YJBYOtherMEDICARE