Provider Demographics
NPI:1316243538
Name:O'HALLORAN, KEVIN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PATRICK
Last Name:O'HALLORAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3015 SQUALICUM PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1906
Mailing Address - Country:US
Mailing Address - Phone:360-733-2092
Mailing Address - Fax:360-788-6042
Practice Address - Street 1:2943 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4411
Practice Address - Country:US
Practice Address - Phone:850-914-7060
Practice Address - Fax:850-914-7065
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2021-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD77843207XX0801X
WAMD61143141207X00000X
FLME130258207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019265400Medicaid