Individual
DR. ASHLEY B. O'BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1160 JOLIET ST STE 204, DYER, IN 46311-2096
(800) 799-2273
(219) 319-5121
Mailing address
1160 JOLIET ST STE 204, DYER, IN 46311-2096
(800) 799-2273
(219) 319-5121
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01070948A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
40481
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN3131004
MEDICARE PTAN
IN
Enumeration date
03/05/2008
Last updated
02/26/2024
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