Provider Demographics
NPI:1154360188
Name:O'HOLLERAN, TIMOTHY PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:O'HOLLERAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6317
Mailing Address - Country:US
Mailing Address - Phone:308-532-8783
Mailing Address - Fax:308-534-3813
Practice Address - Street 1:516 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6533
Practice Address - Country:US
Practice Address - Phone:308-534-5370
Practice Address - Fax:308-534-3813
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15145208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE097795Medicare ID - Type UnspecifiedPROVIDER ID
NEE58174Medicare UPIN