Individual
KEVIN JOHN O BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2302 N STOCKTON HILL RD, SUITE G, KINGMAN, AZ 86401-4100
(928) 854-4307
(928) 854-4339
Mailing address
2302 N STOCKTON HILL RD, SUITE G, KINGMAN, AZ 86401-4100
(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
—
P00156933
RAILROAD MEDICARE
AZ
Enumeration date
10/23/2006
Last updated
08/02/2018
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