Provider Demographics
NPI:1285741348
Name:O'REILLY, BARBARA (MD, PA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 13TH AVE S
Mailing Address - Street 2:STE. 216
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3230
Mailing Address - Country:US
Mailing Address - Phone:904-246-8480
Mailing Address - Fax:904-246-8578
Practice Address - Street 1:1370 13TH AVE S
Practice Address - Street 2:STE. 216
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3230
Practice Address - Country:US
Practice Address - Phone:904-246-8480
Practice Address - Fax:904-246-8578
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55120208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271318700Medicaid
FL0890743012OtherCIGNA PAL ID
FL15099OtherBCBS PROVIDER ID
FL2038410OtherAETNA PROVIDER ID
FL05715Other05715
FL0890743012OtherCIGNA PAL ID