Provider Demographics
NPI:1427036474
Name:O'BRIEN, DAN (DO)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:O'BRIEN
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 1:1902 N COUNTY ROAD 25 E
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454-9222
Mailing Address - Country:US
Mailing Address - Phone:812-723-7450
Mailing Address - Fax:
Practice Address - Street 1:260 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:IN
Practice Address - Zip Code:47452-1724
Practice Address - Country:US
Practice Address - Phone:812-865-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002666A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200524000AMedicaid
INH35712Medicare UPIN
IN200524000AMedicaid