| Entity Name: | JOHN J. O'BRIEN, JR., M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 May 1995 (30 years ago) |
| Document Number: | P95000033577 |
| FEI/EIN Number | 593312517 |
| Address: | 7855 38TH AVE. NORTH, ST PETERSBURG, FL, 33710 |
| Mail Address: | 7855 38TH AVE. NORTH, ST PETERSBURG, FL, 33710 |
| ZIP code: | 33710 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568621522 | 2008-06-05 | 2008-06-05 | 7855 38TH AVE N, ST PETERSBURG, FL, 337101134, US | 7855 38TH AVE N, ST PETERSBURG, FL, 337101134, US | |||||||||||||||||||||||||||||||
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| Phone | +1 727-341-2408 |
| Fax | 7273412708 |
Authorized person
| Name | MS. COLLEEN M O'BRIEN |
| Role | BILLING DEPARTMENT |
| Phone | 7273412408 |
Taxonomy
| Taxonomy Code | 2086S0122X - Plastic and Reconstructive Surgery Physician |
| License Number | ME0066063 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 375259300 |
| State | FL |
| Issuer | BXBS |
| Number | 25235 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| O'BRIEN JOHN J | Agent | 7855 38TH AVE. NORTH, ST PETERSBURG, FL, 33710 |
| Name | Role | Address |
|---|---|---|
| O'BRIEN JOHN J | Director | 7719 HUNTER LANE, PINELLAS PARK, FL, 34666 |
| Name | Role | Address |
|---|---|---|
| O'BRIEN MICHAEL D | Chief Financial Officer | 1021 NEW DAWN LANE, ODENTON, MD, 21113 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000056587 | ST. PETERSBURG CENTER FOR PLASTIC SURGERY | ACTIVE | 2019-05-13 | 2029-12-31 | No data | 7855 38TH AVE N, SAINT PETERSBURG, FL, 33710 |
| G09000139381 | ST. PETERSBURG CENTER FOR PLASTIC SURGERY | EXPIRED | 2009-07-28 | 2014-12-31 | No data | 7855 38TH AVENUE NORTH, ST. PETERSBURG, FL, 33710 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
