Healthcare Provider Details

I. General information

NPI: 1285741348
Provider Name (Legal Business Name): BARBARA O'REILLY M.D., P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 13TH AVE S STE. 216
JACKSONVILLE BEACH FL
32250-3230
US

IV. Provider business mailing address

1370 13TH AVE S STE. 216
JACKSONVILLE BEACH FL
32250-3230
US

V. Phone/Fax

Practice location:
  • Phone: 904-246-8480
  • Fax: 904-246-8578
Mailing address:
  • Phone: 904-246-8480
  • Fax: 904-246-8578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME55120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: