Individual
BRIAN R OBENZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
180 WINGO WAY, SUITE 204, MT PLEASANT, SC 29464-1810
(843) 534-1770
(843) 534-1767
Mailing address
180 WINGO WAY, SUITE 204, MT PLEASANT, SC 29464-1810
(843) 534-1770
(843) 534-1767
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
TL1599
SC
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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