Provider Demographics
| NPI: | 1407831217 |
|---|---|
| Name: | OCONNELL, DANIEL JAMES (MD) |
| Entity Type: | Individual |
| Prefix: | |
| First Name: | DANIEL |
| Middle Name: | JAMES |
| Last Name: | OCONNELL |
| Suffix: | |
| Gender: | M |
| Credentials: | MD |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | PO BOX 601 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DILLINGHAM |
| Mailing Address - State: | AK |
| Mailing Address - Zip Code: | 99576-0601 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 907-842-5201 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 6000 KANAKANAK RD |
| Practice Address - Street 2: | |
| Practice Address - City: | DILLINGHAM |
| Practice Address - State: | AK |
| Practice Address - Zip Code: | 99576 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 907-842-5201 |
| Practice Address - Fax: | 907-842-9250 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2005-12-14 |
| Last Update Date: | 2021-04-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| AK | 790 | 207Q00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| 8EZ664 | Medicare ID - Type Unspecified | ||
| 8EZ714 | Medicare ID - Type Unspecified | ||
| 8EZ724 | Medicare ID - Type Unspecified | ||
| F01100 | Medicare UPIN | ||
| 8EZ654 | Medicare ID - Type Unspecified | ||
| 8EZ674 | Medicare ID - Type Unspecified | ||
| 8EZ604 | Medicare ID - Type Unspecified | ||
| 8EZ634 | Medicare ID - Type Unspecified | ||
| 8EZ504 | Medicare ID - Type Unspecified | ||
| 8EZ533 | Medicare ID - Type Unspecified | ||
| 8EZ694 | Medicare ID - Type Unspecified | ||
| 8EZ523 | Medicare ID - Type Unspecified | ||
| 8EZ553 | Medicare ID - Type Unspecified | ||
| 8EZ613 | Medicare ID - Type Unspecified | ||
| 8EZ543 | Medicare ID - Type Unspecified | ||
| 8EZ624 | Medicare ID - Type Unspecified | ||
| 8EZ644 | Medicare ID - Type Unspecified | ||
| 8EZ684 | Medicare ID - Type Unspecified | ||
| 8EZ704 | Medicare ID - Type Unspecified | ||
| 8EZ514 | Medicare ID - Type Unspecified |
