Individual
JOHN L O'BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1350 HICKORY ST, SUITE 102, MELBOURNE, FL 32901-3224
(321) 434-3455
(321) 434-3456
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-3455
(321) 434-3456
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA9103993
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9103993
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292613000
—
FL
01
—
LE023
FL MEDICARE
FL
01
—
PA9103993
LICENSE
FL
Enumeration date
10/31/2006
Last updated
03/11/2020
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