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General NPI Number Information
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NPI Number | 1215238225
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Entity Type | Organization
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Legal Business Name | DR GERARD O'HALLORAN ENT & FACIAL PLASTIC SURGERY PA
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Dates
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Enumeration Date | 11/07/2010
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Last Update Date | 11/07/2010
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Provider Practice Location Address
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Address Line | 1645 LYNDALE AVE N SUITE 3
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City | FARIBAULT
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State | MN
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Zip | 55021-2934
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Country | US
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Telephone | 612-590-0175
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Fax | 651-493-0968
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Provider Business Mailing Address
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Address Line | 5133 SHERIDAN AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55410-2238
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Country | US
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Telephone | 612-590-0175
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Fax | 651-493-0968
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERARD L O'HALLORAN
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Credential | MD
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Telephone | 612-590-0175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 30984
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License Number State | MN
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