Healthcare Provider Details

I. General information

NPI: 1154307676
Provider Name (Legal Business Name): TIMOTHY O'HARE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 S APOLLO BLVD STE 301
MELBOURNE FL
32901-3183
US

IV. Provider business mailing address

1344 S APOLLO BLVD STE 301
MELBOURNE FL
32901-3183
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-2353
  • Fax: 321-951-9267
Mailing address:
  • Phone: 321-676-2353
  • Fax: 321-951-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME84166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: