Healthcare Provider Details

I. General information

NPI: 1821154121
Provider Name (Legal Business Name): RYAN GENE O'HARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5343 S. WOODROW ST.
MURRAY UT
84107
US

IV. Provider business mailing address

5343 S WOODROW ST
MURRAY UT
84107-5840
US

V. Phone/Fax

Practice location:
  • Phone: 801-810-2999
  • Fax: 801-396-9157
Mailing address:
  • Phone: 801-810-2999
  • Fax: 801-396-9157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number7832708-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7832708-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036.176508
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMT189294
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036.176508
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: