Provider Demographics
NPI:1538394960
Name:O'BRIEN, ALISSA KATE (MD)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:KATE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:KATE
Other - Last Name:ORVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 VILLAGE SQUARE XING
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4543
Mailing Address - Country:US
Mailing Address - Phone:561-694-9493
Mailing Address - Fax:
Practice Address - Street 1:600 VILLAGE SQUARE XING
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4543
Practice Address - Country:US
Practice Address - Phone:561-694-9493
Practice Address - Fax:561-694-9493
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN13817207R00000X
FLME115399207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine