MEDICARE: DR. KEVIN PATRICK O'HALLORAN MD

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	207XX0801X	Orthopaedic Trauma Physician	D77843	MD
2	207X00000X	Orthopaedic Surgery Physician	MD61143141	WA
3	207XX0801X	Orthopaedic Trauma Physician	ME130258	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316243538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN PATRICK O'HALLORAN MD

Provider Business Mailing Address
First Line	:	3015 SQUALICUM PKWY
Second Line	:	STE 200
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1906
Country	:	US
Telephone Number	:	360-733-2092
Fax Number	:	360-788-6042

Provider Business Practice Location Address
First Line	:	2943 HIGHWAY 77
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4411
Country	:	US
Telephone Number	:	850-914-7060
Fax Number	:	850-914-7065

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

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	12/02/2021

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