Organization
KEVIN J OBRIEN DPM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHN OBRIEN DPM (OWNER)
(928) 854-4307
Entity
Organization
Contact information
Practice address
1731 MESQUITE AVE STE 4, LAKE HAVASU CITY, AZ 86403-5653
(928) 854-4307
(928) 854-4339
Mailing address
PO BOX 3028, LAKE HAVASU CITY, AZ 86405
(928) 854-4307
(928) 854-4339
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0541
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
572124
—
AZ
01
—
DC2459
RAILROAD MEDICARE
AZ
Enumeration date
10/16/2007
Last updated
03/07/2023
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