Healthcare Provider Details

I. General information

NPI: 1497740203
Provider Name (Legal Business Name): JOHN DENNIS O BRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N 12TH ST SUITE 100
OSKALOOSA IA
52577-2495
US

IV. Provider business mailing address

410 N 12TH ST SUITE 100
OSKALOOSA IA
52577-2495
US

V. Phone/Fax

Practice location:
  • Phone: 641-672-3360
  • Fax: 641-672-3366
Mailing address:
  • Phone: 641-672-3360
  • Fax: 641-672-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29352
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: