Provider Demographics
NPI:1407859051
Name:EBY, DANIEL C (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:EBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W. 13TH ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1883
Mailing Address - Country:US
Mailing Address - Phone:812-482-7441
Mailing Address - Fax:812-482-7444
Practice Address - Street 1:600 W. 13TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1883
Practice Address - Country:US
Practice Address - Phone:812-482-7441
Practice Address - Fax:812-482-7444
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001643A207XX0005X
IN02001643207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000332839OtherANTHEM BLUE CROSS BLUE SH
IN200042870Medicaid
IN5160900001OtherMEDICARE DME
IN200042870AMedicaid
IN200021790OtherRAILROAD MEDICARE
IN5160900001OtherMEDICARE DME
IN200042870Medicaid
IN000000332839OtherANTHEM BLUE CROSS BLUE SH