Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS-014927-L | PA |
NPI | 1003822636 |
---|---|
Provider Name | Dr. Robert J O'leary |
First Address | Corry, PA 16407-1655 |
Second Address | Corry, PA 16407-1655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |