Basic Information
| Provider Information | |||||||||
| NPI: | 1700816592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'MAHONEY | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 NE 45TH ST STE 214 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333085136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544935005 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4725 N FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333084603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547718000 | ||||||||
| FaxNumber: | 6148840776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | OS14497 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | OM4185821 | 01 | OH | MEDICARE ID-TYPE UNSPECIFIED | OTHER | 2667476 | 05 | OH | MEDICAID |