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
StateLicense IDTaxonomies
AK790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8EZ664Medicare ID - Type Unspecified
8EZ714Medicare ID - Type Unspecified
8EZ724Medicare ID - Type Unspecified
F01100Medicare UPIN
8EZ654Medicare ID - Type Unspecified
8EZ674Medicare ID - Type Unspecified
8EZ604Medicare ID - Type Unspecified
8EZ634Medicare ID - Type Unspecified
8EZ504Medicare ID - Type Unspecified
8EZ533Medicare ID - Type Unspecified
8EZ694Medicare ID - Type Unspecified
8EZ523Medicare ID - Type Unspecified
8EZ553Medicare ID - Type Unspecified
8EZ613Medicare ID - Type Unspecified
8EZ543Medicare ID - Type Unspecified
8EZ624Medicare ID - Type Unspecified
8EZ644Medicare ID - Type Unspecified
8EZ684Medicare ID - Type Unspecified
8EZ704Medicare ID - Type Unspecified
8EZ514Medicare ID - Type Unspecified