Healthcare Provider Details

I. General information

NPI: 1669442893
Provider Name (Legal Business Name): TIMOTHY O'LEARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W GORE ST
ORLANDO FL
32806-1008
US

IV. Provider business mailing address

207 W GORE ST STE 300
ORLANDO FL
32806-1014
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-8555
  • Fax: 321-841-2425
Mailing address:
  • Phone: 321-841-8555
  • Fax: 321-841-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME54982
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME54982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: