Provider Demographics
NPI:1417702648
Name:ROYAL O'BRIEN, CHARIS RENAI (MD)
Entity type:Individual
Prefix:
First Name:CHARIS
Middle Name:RENAI
Last Name:ROYAL O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARIS
Other - Middle Name:RENAI
Other - Last Name:ROYAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:50 N DUNLAP 6TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-3438
Mailing Address - Country:US
Mailing Address - Phone:901-448-1010
Mailing Address - Fax:
Practice Address - Street 1:920 MADISON AVE STE 447
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3438
Practice Address - Country:US
Practice Address - Phone:901-448-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program