Provider Demographics
NPI:1699895458
Name:O'BRYAN, DALE (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:O'BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 MANSELL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-3068
Mailing Address - Country:US
Mailing Address - Phone:770-643-5511
Mailing Address - Fax:678-352-4350
Practice Address - Street 1:9450 SW 5TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2112
Practice Address - Country:US
Practice Address - Phone:305-221-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME502042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E8246BMedicare ID - Type Unspecified
71363Medicare UPIN