Provider Demographics
NPI:1497740203
Name:O BRIEN, JOHN DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DENNIS
Last Name:O BRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 N 12TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2495
Mailing Address - Country:US
Mailing Address - Phone:641-672-3360
Mailing Address - Fax:641-672-3366
Practice Address - Street 1:410 N 12TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2495
Practice Address - Country:US
Practice Address - Phone:641-672-3360
Practice Address - Fax:641-672-3366
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA29352208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0097964Medicaid
IA51223OtherWELLMARK, INC BCBS OF IOW
IA62769OtherIOWA HEALTH SOLUTIONS
IAG005OtherTRIWEST
IA42068106028OtherJOHN DEERE HEALTH
IA51223OtherWELLMARK, INC BCBS OF IOW