Individual
DR. JERRY V O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5900 BYRON CENTER AVE SW, METRO HEALTH HOSPITAL, WYOMING, MI 49519-9606
(616) 808-3944
(616) 808-3948
Mailing address
400 ANN ST NW, SUITE 209, GRAND RAPIDS, MI 49504-2052
(616) 808-3944
(616) 808-3948
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
5101009941
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3318319
—
MI
01
—
5704503
BCBS PIN NUMBER
MI
01
—
CE1952
RAILROAD GROUP BILL PIN
MI
01
—
JO009941
BCBS LICENSE NUMBER
MI
Enumeration date
04/11/2006
Last updated
04/08/2008
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