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General NPI Number Information
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NPI Number | 1275741829
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Entity Type | Individual
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Provider Name | DANIEL ERIC O'BRIEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 928 W MOUNT VERNON ST
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City | METAMORA
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State | IL
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Zip | 61548-6004
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Country | US
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Telephone | 309-367-2321
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Fax |
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Provider Business Mailing Address
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Address Line | 928 W MOUNT VERNON ST
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City | METAMORA
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State | IL
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Zip | 61548-6004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036121512
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036121512
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License Number State | IL
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