1194774547 NPI number — DR. PATRICK J O'LEARY M.D.

Table of content: DR. PATRICK J O'LEARY M.D. (NPI 1194774547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194774547 NPI number — DR. PATRICK J O'LEARY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'LEARY
Provider First Name:
PATRICK
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194774547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
364 SE 8TH AVE
Provider Second Line Business Mailing Address:
SUITE 301A
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97123-4253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-681-4310
Provider Business Mailing Address Fax Number:
503-681-1989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
364 SE 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE 301A
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97123-4253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-681-4310
Provider Business Practice Location Address Fax Number:
503-681-1989
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  A83444 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: MD27751 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0080690 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00110345 . This is a "PALMETTO RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0080690 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007052486 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ54573Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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