Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 12073 | NV |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 12073 | NV |
Y | 207XX0801X | Orthopaedic Trauma Surgeon | 12073 | NV |
NPI | 1386787984 |
---|---|
Provider Name | Timothy James O'mara |
First Address | Reno, NV 89503-4723 |
Second Address | Reno, NV 89503-4723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11531555 | CAQH (01) | |
I31433 | (02) |