MEDICARE: MR. JOHN F. O'MARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1043246051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN F. O'MARA

Provider Business Mailing Address
First Line	:	16644 N BOXCAR DR
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-1327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16644 N BOXCAR DR
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-1327
Country	:	US
Telephone Number	:	602-463-1166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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