Healthcare Provider Details

I. General information

NPI: 1316029960
Provider Name (Legal Business Name): DC OBRIEN ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S MAPLE ST
ORLEANS IN
47452-1724
US

IV. Provider business mailing address

260 S MAPLE ST
ORLEANS IN
47452-1724
US

V. Phone/Fax

Practice location:
  • Phone: 812-865-3350
  • Fax: 812-865-3814
Mailing address:
  • Phone: 812-865-3350
  • Fax: 812-865-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02002666A
License Number StateIN

VIII. Authorized Official

Name: DANIEL P OBRIEN
Title or Position: OWNER
Credential: DO
Phone: 812-865-3350