Provider Demographics
NPI:1962534032
Name:O'BRIEN, ALIX (PA)
Entity type:Individual
Prefix:
First Name:ALIX
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 E MAIN ST
Mailing Address - Street 2:#307
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1953
Mailing Address - Country:US
Mailing Address - Phone:970-945-1144
Mailing Address - Fax:970-945-9138
Practice Address - Street 1:1830 BLAKE AVE
Practice Address - Street 2:#207
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4275
Practice Address - Country:US
Practice Address - Phone:970-945-1144
Practice Address - Fax:970-945-9138
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2256363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical