Provider Demographics
NPI:1952283764
Name:O'BRIEN, GREGORY J
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9681 COOK RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:LA
Mailing Address - Zip Code:71007
Mailing Address - Country:US
Mailing Address - Phone:314-952-6214
Mailing Address - Fax:
Practice Address - Street 1:9681 COOK RD
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:LA
Practice Address - Zip Code:71007
Practice Address - Country:US
Practice Address - Phone:314-952-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program