Healthcare Provider Details

I. General information

NPI: 1376541789
Provider Name (Legal Business Name): WALTER W OHARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 FANNIN ST SUITE 1401
HOUSTON TX
77030-2717
US

IV. Provider business mailing address

6550 FANNIN ST SUITE 1401
HOUSTON TX
77030-2717
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-5200
  • Fax: 713-793-7428
Mailing address:
  • Phone: 713-441-5200
  • Fax: 713-793-7428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0429755
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberN8699
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: