Healthcare Provider Details

I. General information

NPI: 1427036474
Provider Name (Legal Business Name): DAN O'BRIEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S MAPLE ST
ORLEANS IN
47452-1724
US

IV. Provider business mailing address

1902 N COUNTY ROAD 25 E
PAOLI IN
47454-9222
US

V. Phone/Fax

Practice location:
  • Phone: 812-865-3350
  • Fax:
Mailing address:
  • Phone: 812-723-7450
  • Fax:

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:
Title or Position:
Credential:
Phone: