MEDICARE: MICHAEL O'GARA

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	207Q00000X	Family Medicine Physician	08605	OR

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	:	1740346956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL O'GARA

Provider Business Mailing Address
First Line	:	PO BOX 1215
Second Line	:
City	:	GOLD BEACH
State	:	OR
Zip	:	97444-1215
Country	:	US
Telephone Number	:	541-247-6628
Fax Number	:	541-247-6629

Provider Business Practice Location Address
First Line	:	94125 4TH ST
Second Line	:
City	:	GOLD BEACH
State	:	OR
Zip	:	97444-1215
Country	:	US
Telephone Number	:	541-247-6628
Fax Number	:	541-247-6629

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL THOMAS O'GARA
Credential	:	DO
Telephone Number	:	541-247-6628

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	06/30/2010

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