Provider Demographics
NPI:1396700803
Name:O'BRIEN, THOMAS W (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1121 N CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4405
Mailing Address - Country:US
Mailing Address - Phone:407-933-1221
Mailing Address - Fax:407-933-0747
Practice Address - Street 1:1121 N CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4405
Practice Address - Country:US
Practice Address - Phone:407-933-1221
Practice Address - Fax:407-933-0747
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2018-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL0056928207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52669000Medicaid
FL52669000Medicaid
FLE67522Medicare UPIN