Provider Demographics
NPI:1194774547
Name:O'LEARY, PATRICK J (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:O'LEARY
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 1:364 SE 8TH AVE
Mailing Address - Street 2:SUITE 301A
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4253
Mailing Address - Country:US
Mailing Address - Phone:503-681-4310
Mailing Address - Fax:503-681-1989
Practice Address - Street 1:364 SE 8TH AVE
Practice Address - Street 2:SUITE 301A
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4253
Practice Address - Country:US
Practice Address - Phone:503-681-4310
Practice Address - Fax:503-681-1989
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83444208600000X
ORMD27751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080690OtherMEDI-CAL
CAP00110345OtherPALMETTO RAILROAD MEDICARE
CAGR0080690Medicaid
CA0007052486OtherAETNA
CAZZZ54573ZOtherBLUE SHIELD
CAI00240Medicare UPIN